Verification of Benefits Specialist

Plano, Texas -100 percent onsite

Days/Hours: Mon – Friday 8:00am-5:00 PM

Selected Candidate will start ASAP after screenings have cleared.

Length of Assignment: 6 months/ possible extension

• HS diploma required, AA a plus
• 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
• Has worked in a physician’s office or physicians background
• Strong communication skills
• Strong organizational skills
• Understanding co insurance and benefit understanding

Top skills:

• Experience with insurance carriers
• Experience with verification of benefits and portals
• Proficient with computer, adobe, sales force, Microsoft office

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 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 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 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 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

EDUCATION AND EXPERIENCE YOU’LL BRING

Required

• 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

Preferred

• 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