Patient Therapy Access Specialist

Abbott•Plano, TX

1d•$21 - $41

About The Position

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. JOB DESCRIPTION: Patient Therapy Access: Patient Therapy Access Specialist Grade 06 : Hourly Position 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.

Requirements

High School Diploma / GED an equivalent combination of education and work experience
Minimum 3 years, In fast paced data entry and administrative role.
General knowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.
Some experience in medical device or DME Billing a plus.
Proficient with Microsoft Office (Word & Excel specifically).
Some 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 and share workloads with other team members.
Excellent communication skills; verbal and written.
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.
Minimum 2 years, In a utilization (medical approval) environment or similar work experience.

Nice To Haves

Associate’s Degree Preferred
Knowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective 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 and utilizing various insurance payor portals (e.g., Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield)
Efficiently submits and manages precertification and prior authorization requests
Understands payer-specific requirements and documentation standards
Tracks and follows up on pending authorizations to ensure timely approvals
Able to troubleshoot portal issues and escalate when necessary

Responsibilities

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