Lead Patient Therapy Access

Abbott • Plano, TX

1d • Onsite

About The Position

Abbott is a global healthcare leader dedicated to helping people live more fully at all stages of life, offering a portfolio of life-changing technologies in diagnostics, medical devices, nutritionals, and branded generic medicines. With 115,000 colleagues serving over 160 countries, Abbott provides an environment for career growth, learning, and personal well-being. The company is recognized as a great place to work globally, including for diversity, working mothers, female executives, and scientists. Abbott's medical device businesses focus on faster, more effective, and less invasive technologies, such as glucose monitoring systems, heart disease therapies, and products for chronic pain and movement disorders, aiming to improve lives daily. This role is responsible for leading a team that facilitates and assists Abbott patients with the pre-certification, determination, and authorization processes required for various procedures or therapies based on physician recommendations. The Lead Patient Therapy Access also supports Patient Therapy Access Specialists in navigating questions, concerns, and obstacles in standard work processing, handles multiple levels of appeal for coverage denials, forwards authorization confirmations to providers, and provides regular updates to patients and providers on case status.

Requirements

• Associates Degree (± 13 years), In Nursing/Home Health (LVN/LPN) or related field OR an equivalent combination of education and work experience
• Minimum 2 years, In a utilization (medical approval), payer or healthcare economics and reimbursement environment or similar work experience.
• General knowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.
• Proficient with Microsoft Office (Word & Excel specifically).
• Knowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding).
• Ability to accurately meet required time frames/deadlines.
• Ability to work as a team player while informally leading other team members.
• Excellent communication skills; verbal and written.
• Ability to train/present concepts to others.
• Previous experience in public speaking or presenting to small groups.
• Attention to detail.
• Ability to travel 5% of the time.
• Excellent organization skills and ability to multi-task in a fast-paced environment.

Nice To Haves

• Experience in medical device or DME Billing a plus.
• Medical billing software experience a plus.

Responsibilities

• Responsible for managing multiple cases simultaneously within specific time frames.
• Assist with standard case processing as and when necessary.
• Follow all policies and procedures related to performing the job role adhering to all data use, storage and privacy policies as outlined by Abbott.
• Participate in implementing department improvement strategies and maintaining department compliance and regulatory guidelines.
• Navigate and own complex appeals process in assigned region.
• Act as front line for general questions from the team that arise on a day to day basis.
• Verify benefits, complete authorization requests promptly.
• Timely follow up for requested authorizations.
• For each procedure, audit required clinical documents for completeness and accuracy.
• Complete labeling audit to confirm case is considered to be on-label for device indications.
• Obtain authorization for the facility, equipment and physician to perform 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.
• Act as an example for compliance, correct processing, positive engagement.
• Team culture ambassador.
• Provide insight to the leadership team based on conversations and observations made on the floor.

Benefits

• Career development with an international company where you can grow the career you dream of.
• Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year.
• An excellent retirement savings plan with high employer contribution
• Tuition reimbursement, the Freedom 2 Save student debt program and FreeU education benefit - an affordable and convenient path to getting a bachelor’s degree.
• A company recognized as a great place to work in dozens of countries around the world and named one of the most admired companies in the world by Fortune.
• A company that is recognized as one of the best big companies to work for as well as a best place to work for diversity, working mothers, female executives, and scientists.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees