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. This role, Lead Patient Therapy Access, is responsible for leading a team that facilitates and assists Abbott patients with the pre-certification, determination, and authorization process required for various procedures or forms of therapy based on physician recommendations. The position also involves assisting Patient Therapy Access Specialists with navigating questions, concerns, and obstacles related to standard work processing. Key aspects include managing multiple levels of appeal in cases of initial coverage denial, forwarding authorized confirmations to designated patient providers, and providing regular updates to patients and providers regarding case status and next steps. This role is part of Abbott's medical device businesses, which develop technologies for glucose monitoring, heart disease treatment, and products for chronic pain or movement disorders.

Requirements

• Associates Degree (± 13 years), In Nursing/Home Health (LVN/LPN) or related field required 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.
• Medical billing software experience.

Responsibilities

• Managing multiple cases simultaneously within specific time frames.
• Assisting with standard case processing as and when necessary.
• Following all policies and procedures related to performing the job role adhering to all data use, storage and privacy policies as outlined by Abbott.
• Participating in implementing department improvement strategies and maintaining department compliance and regulatory guidelines.
• Navigating and owning complex appeals process in assigned region.
• Acting as front line for general questions from the team that arise on a day to day basis.
• Verifying 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.
• FreeU education benefit - an affordable and convenient path to getting a bachelor’s degree.

What This Job Offers

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