Verification of Benefits Specialist

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 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

EDUCATION AND EXPERIENCE YOU LL BRING

Required

• Associate degree in Nursing/Home Health (LVN/LPN) or related field required.
• Minimum of 2 plus yrs experience in a utilization (medical approval) environment or similar work experience

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)
• 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