Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 115,000 colleagues serve people in more than 160 countries.
Our location in Plano, TX currently has an opportunity for a Patient Therapy Access Specialist (PTA). As a PTA Specialist you are responsible for facilitating and assisting Abbott patients with the pre-certification, pre-determination and authorization process necessary as a prerequisite to perform various procedures or forms of therapy based on physician recommendation.
WHAT YOU’LL DO
Assist with multiple levels of appeal in the event of initial coverage denial.
Forward authorized confirmation for procedure to designated patient provider. In addition, this position will provide in-servicing to new patient providers surrounding the pre-authorization process.
Responsible for managing multiple cases simultaneously within specific time frames
Follow all policies and procedures related to performing the job role adhering to all data use, storage and privacy policies as outlined by Abbott
Verify benefits, complete authorization requests promptly
Timely follow up for requested authorizations
For each procedure, audit required clinical documents for completeness and accuracy
Obtain authorization for the facility, equipment and physician to perform various procedures from the insurance carrier
Work with key provider contacts to obtain required clinical information for authorizations
Work with respective carrier’s utilization review department to obtain appropriate authorizations
Work within established guidelines when necessary to process appeal for denied requests
Train patients and their designated providers on pre-authorization processes and requirements, in person or by phone
Work individually and in a team environment to educate assigned Field Territory Managers and Clinical Specialists
RequiredQualifications
PreferredQualifications
Knowledge of private insurance, Worker’s Compensation and Medicare guidelinespertaining toProspective and Retrospective Utilization Review.
Experience in medical device or DME Billing a plus
Proficient with Microsoft Office (Word & Excel specifically)
Medical billing software experience a plus
Knowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding)
Knowledge of medical terminology
Ability to accurately meet required time frames/deadlines
Ability to work as a team player and share workloads with other team members
Excellent verbal and written communication skills
Ability to train/present concepts to others
Proficient in navigating andutilizingvarious insurance payor portals(e.g., Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield)
Efficientlysubmitsand manages precertification and prior authorization requests
Understands payer-specific requirements and documentation standards
Tracks and follows up on pending authorizations to ensuretimelyapprovals
Able to troubleshoot portal issues and escalate when necessary
The base pay for this position is $20.50 – $41.00 per hour. In specific locations, the pay range may vary from the range posted.