Verification of Benefits Specialist

Position Title: Verification of Benefits Specialist Work Location: Plano, Texas Assignment Duration: 5+ Months Work Schedule: Mon - Friday 8:00 AM - 5:00 PM Work Arrangement: Onsite Position Summary As a PTA Specialist you are responsible for facilitating and assisting 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. Key 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 Responsible for managing multiple cases simultaneously within specific time frames Follow all policies and procedures related to performing the job role Verify benefits, complete authorization requests promptly Timely follow up for requested authorizations 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 utilization review departments to obtain appropriate authorizations Process appeals for denied requests within established guidelines Train patients and designated providers on pre-authorization processes and requirements Work individually and in a team environment to educate assigned Field Territory Managers and Clinical Specialists Qualification & Experience HS diploma required, AA a plus Minimum of 2 plus yrs experience in a utilization (medical approval) environment or similar work experience 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 Helping all candidates find great careers is our goal. The information you provide here is secure and confidential. #J-18808-Ljbffr