Patient Therapy Access Specialist

Abbott•Plano, TX

2d•Onsite

About The 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

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) 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).
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.

Nice To Haves

Some experience in medical device or DME Billing a plus.
Medical billing software experience a plus.
Knowledge of medical terminology.
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.
Provide in-servicing to new patient providers surrounding the pre-authorization process.
Manage 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.
Audit required clinical documents for completeness and accuracy for each procedure.
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.
Process appeal for denied requests within established guidelines.
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.