Job Description

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, nutritionals and branded generic medicines. Our 115,000 colleagues serve people in more than 160 countries.

Our location in Plano, TX currently has an opportunity for a Patient Therapy Access Specialist (PTA). As a PTA Specialist you are responsible for facilitating and assisting Abbott 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 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

Required Qualifications

• Associates Degree (± 13 years) In Nursing/Home Health (LVN/LPN) or related field required OR an equivalent combination of education and work experience
  Minimum 2 years
• In a utilization (medical approval) environment or similar work experience.
• General knowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.
• Some experience in medical device or DME Billing a plus.
• Proficient with Microsoft Office (Word & Excel specifically).
• Some 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 communication skills; verbal and written.
• Previous experience in public speaking or presenting to small groups.
• Attention to detail.
• Ability to travel 5% of the time.
• Excellent organization skills and ability to multi-task in a fast-paced environment.

Preferred Qualifications

• 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)

• Knowledge of medical terminology

• 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

• Proficient in navigating and utilizing various insurance payor portals (e.g., Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield)

• Efficiently submits and manages precertification and prior authorization requests

• Understands payer-specific requirements and documentation standards

• Tracks and follows up on pending authorizations to ensure timely approvals

• Able to troubleshoot portal issues and escalate when necessary

The base pay for this position is

$20.50 – $41.00/hour

In specific locations, the pay range may vary from the range posted.

JOB FAMILY:

Clinical Affairs / Statistics

DIVISION:

MD Medical Devices

LOCATION:

United States > Texas > Plano : 6600 Pinecrest

ADDITIONAL LOCATIONS:

WORK SHIFT:

Standard

TRAVEL:

No

MEDICAL SURVEILLANCE:

No

SIGNIFICANT WORK ACTIVITIES:

Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day), Keyboard use (greater or equal to 50% of the workday)Abbott is an Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans.EEO is the Law link - English: http://webstorage.abbott.com/common/External/EEO_English.pdfEEO is the Law link - Espanol: http://webstorage.abbott.com/common/External/EEO_Spanish.pdf