Verification of Benefits Specialist

Title: Verification of Benefits Specialist Location: Plano, TX Duration: 6+ month 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 Qualifications: 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 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. Consultants Eligible Benefits Upon Waiting Period: Medical and Prescription Drug Plans Dental Plan Vision Plan Health Savings Account (for High-Deductible Health Plans) Flexible Spending Accounts (Health, Limited Purpose, Dependent Care, Commuter Parking and Commuter Transit) Supplemental Life Insurance Short Term Disability (coverage varies by state) Long Term Disability Critical Illness, Hospital coverage, Accident Insurance MetLife Legal, MetLife ID Fraud, and MetLife Pet Insurance 401(k) 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, nutritional and branded generic medicines. Working together, Abbott and Talent Solutions partner to deliver top talent for contingent roles at Abbott, building better and healthier lives. Abbott believes all employees are essential to creating life-changing breakthroughs, performing key duties to create life-changing breakthroughs. #J-18808-Ljbffr