Sr. Appeals Specialist, Patient Therapy Access Team
4 weeks ago
Sr. Appeals Specialist, Patient Therapy Access Team
Position Location: 6600 Pinecrest Drive Plano, TX 75024
NOTE: This position is required to be in-office five (5) days a week. This is not a hybrid or fully remote position.
Working at Abbott
At Abbott, you can do work that matters, grow, and learn, care for yourself and family, be your true self and live a full life. Youâll also have access to:
- Career development with an international company where you can grow the career you dream of.
- Free medical coverage for employees* via the Health Investment Plan (HIP) PPO
- An excellent retirement savings plan with high employer contribution
- Tuition reimbursement, the Freedom 2 Save student debt program and FreeU education benefit - an affordable and convenient path to getting a bachelorâs degree.
- A company recognized as a great place to work in dozens of countries around the world and named one of the most admired companies in the world by Fortune.
- A company thatâs recognized as one of the best big companies to work for as well as a best place to work for diversity, working mothers, female executives, and scientists.
The Opportunity
Our location in Plano, TX currently has an opportunity for a Sr. Appeals Specialist. This role is responsible for facilitating and assisting Abbott patients with the pre-certification, determination, and authorization process necessary as a prerequisite to perform various procedures or forms of therapy based on physician recommendation. Lead efforts to develop programs that assist with multiple levels of appeal in the event of initial coverage denial. Manage complex appeals cases for assigned region including taking ownership of cases following initial denial. Forward authorized confirmation for procedure to designated patient provider. In addition, this position will take the lead on in-servicing provided to new patient providers surrounding the pre-authorization process. Act as conduit for policy and coverage training/updates to the Patient Therapy Access Specialist team by partnering with team leadership and Abbottâs Healthcare Economics & Reimbursement representatives.
What Youâll Work On
- 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.
- Navigate and own complex appeals process in assigned region.
- Act as SME for all coverage policies and authorization requirements for assigned carriers.
- Verify benefits and 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 procedures from the insurance carrier.
- Work with key provider contacts to obtain required clinical information for authorizations.
- Work with respective carrierâs 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.
Required Qualifications
- Bachelorâs degree in Nursing/Home Health (LVN/LPN) or related field required, or equivalent combination of education, training, and experience.
- Minimum of 3+ yearsâ experience in a utilization (medical approval), payer or healthcare economics and reimbursement environment or similar/relevant work experience.
- General knowledge of private insurance, Workerâs 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).
- Knowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding).
Preferred Qualifications
- Medical billing software experience a plus.
- Ability to accurately meet required time frames/deadlines.
- Excellent communication skills; verbal and written.
- Ability to train/present concepts to others.
- Ability to work as a team player and share workloads with other team members.
- Previous experience in public speaking or presenting to small groups.
- Excellent organization skills and ability to multi-task in a fast-paced environment.
- 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.
- Ability to train/present concepts to others.
* Participants who complete a short wellness assessment qualify for FREE coverage in our HIP PPO medical plan. Free coverage applies in the next calendar year.
Learn more about our health and wellness benefits, which provide the security to help you and your family live full lives:Â www.abbottbenefits.com
Follow your career aspirations to Abbott for diverse opportunities with a company that can help you build your future and live your best life. Abbott is an Equal Opportunity Employer, committed to employee diversity.
Connect with us at www.abbott.com, on Facebook at www.facebook.com/Abbott and on Twitter @AbbottNews.
The base pay for this position is $48,000.00 â $96,000.00. In specific locations, the pay range may vary from the range posted.
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