VOB Specialist - Patient Therapy

Patient Therapy Access Specialist (PTA)

Our Plano, TX, currently has an opportunity for a Patient Therapy Access Specialist (PTA). As a PTA Specialist, you are responsible for facilitating and assisting Client 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. What you'll do:

• Assist with multiple levels of appeal in the event of initial coverage denial.
• Forward authorized confirmation for the procedure to the designated patient provider.
• In addition, this position will provide in-service training 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 the Client
• 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 the required clinical information for authorizations
• Work with the respective carrier's utilization review department to obtain appropriate authorizations
• Work within established guidelines when necessary to process appeals 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 will bring (Required):

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

Preferred:

• Knowledge of private insurance, Worker's Compensation, and Medicare guidelines about Prospective and Retrospective Utilization Review.
• Experience in medical device or DME Billing is a plus
• Proficient with Microsoft Office (Word & Excel specifically)
• Medical billing software experience is 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