Abbott Senior Patient Therapy Access Assistant (Case Manager) in Plano, Texas
At Abbott, we're committed to helping people live their best possible life through the power of health. For more than 125 years, we've brought new products and technologies to the world -- in nutrition, diagnostics, medical devices and branded generic pharmaceuticals -- that create more possibilities for more people at all stages of life. Today, 99,000 of us are working to help people live not just longer, but better, in the more than 150 countries we serve.
Job Summary : Briefly state the main purpose and scope of the job.
This position is responsible for obtaining pre-certification, determination and authorization for the facility, equipment and physician's fees to perform spinal cord stimulation based on physician recommendation. Forward authorized confirmation for procedure to facility, physician and representative.
Job Duties : List the significant/essential duties, tasks or responsibilities which employees in this position are required to perform.
• Responsible for managing multiple cases simultaneously within specific time frames
• Verify benefits, complete authorization requests promptly
• Timely follow up for requested authorizations
• For each procedure, audit required clinical documents for completeness and accuracy for the respective carrier.
• Obtain authorization for the facility, equipment and physician to perform spinal cord stimulation procedures from the insurance carrier.
• Work with key customer contacts to obtain required clinical information for authorizations
• Work with respective carriers utilization review department to obtain appropriate authorizations
• Work within established guidelines when necessary to process appeal for denied requests
• Act as subject matter expert to physicians and facilities for correct claim coding
• Work in a team environment to educate and support assigned Field Territory Managers and Clinical Specialist
• Support all Company initiatives as identified by management and in support of Quality Management Systems (QMS), Environmental Management Systems (EMS), and other regulatory requirements.
• Complies with U.S. Food and Drug Administration (FDA) regulations, other regulatory requirements, Company policies, operating procedures, processes, and task assignments. Maintains positive and cooperative communications and collaboration with all levels of employees, customers, contractors, and vendors.
• Performs other related duties and responsibilities, on occasion, as assigned.
Q ualifications : Describe the minimum education and experience, including knowledge, skills and abilities, required to successfully perform the job. List any certificates, license, and/or registrations required.
• Associate degree in Nursing/Home Health or related field. LVN/LPN strongly preferred.
• 2 plus years of experience in a utilization (medical approval) environment or similar work experience
• Experience in medical or DME Billing a plus
• Proficient with Microsoft Office (Word & Excel specifically) medical billing software a plus Knowledge of current CPT codes and familiarity with ICD-9CM (diagnosis coding)
• General knowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.
• Experience working in a broader enterprise/cross-division business unit model preferred.
• Ability to work in a highly matrixed and geographically diverse business environment.
• Ability to work within a team and as an individual contributor in a fast-paced, changing environment.
• Ability to leverage and/or engage others to accomplish projects.
• Strong verbal and written communications with ability to effectively communicate at multiple levels in the organization.
• Multitasks, prioritizes and meets deadlines in timely manner.
• Strong organizational and follow-up skills, as well as attention to detail.
• Ability to travel approximately XX%, including internationally.
• Ability to maintain regular and predictable attendance.
• Occasional or Regularly scheduled overtime is a requirement of this position.
An Equal Opportunity Employer
Abbot welcomes and encourages diversity in our workforce.
We provide reasonable accommodation to qualified individuals with disabilities.
To request accommodation, please call 224-667-4913 or email email@example.com