Description: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 DOAssist 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 framesFollow all policies and procedures related to performing the job role adhering to all data use, storage and privacy policies as outlined by the clientVerify benefits, complete authorization requests promptlyTimely follow up for requested authorizationsFor each procedure, audit required clinical documents for completeness and accuracyObtain authorization for the facility, equipment and physician to perform various procedures from the insurance carrierWork with key provider contacts to obtain required clinical information for authorizationsWork with respective carrier’s utilization review department to obtain appropriate authorizationsWork within established guidelines when necessary to process appeal for denied requestsTrain patients and their designated providers on pre-authorization processes and requirements, in person or by phoneWork individually and in a team environment to educate assigned Field Territory Managers and Clinical SpecialistsEDUCATION AND EXPERIENCE YOU’LL BRINGRequiredHS diploma required, AA a plusMinimum of 2 plus yrs experience in a utilization (medical approval) environment or similar work experiencePreferredKnowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.Experience in medical device or DME Billing a plusProficient with Microsoft Office (Word & Excel specifically)Medical billing software experience a plusKnowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding)Ability to accurately meet required time frames/deadlinesAbility to work as a team player and share workloads with other team membersExcellent verbal and written communication skillsAbility to train/present concepts to othersHas worked in a physician’s office or physicians background Strong communication skills Strong organizational skills Understanding co insurance and benefit understandingTop skills:Experience with insurance carriersExperience with verification of benefits and portalsProficient with computer, adobe, sales force, Microsoft officeNotes:8:00am - 5:00pm VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status
Description: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 DOAssist 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 framesFollow all policies and procedures related to performing the job role adhering to all data use, storage and privacy policies as outlined by the clientVerify benefits, complete authorization requests promptlyTimely follow up for requested authorizationsFor each procedure, audit required clinical documents for completeness and accuracyObtain authorization for the facility, equipment and physician to perform various procedures from the insurance carrierWork with key provider contacts to obtain required clinical information for authorizationsWork with respective carrier’s utilization review department to obtain appropriate authorizationsWork within established guidelines when necessary to process appeal for denied requestsTrain patients and their designated providers on pre-authorization processes and requirements, in person or by phoneWork individually and in a team environment to educate assigned Field Territory Managers and Clinical SpecialistsEDUCATION AND EXPERIENCE YOU’LL BRINGRequired
HS diploma required, AA a plus
Minimum of 2 plus yrs experience in a utilization (medical approval) environment or similar work experience
PreferredKnowledge of private insurance, Worker’s Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.Experience in medical device or DME Billing a plusProficient with Microsoft Office (Word & Excel specifically)Medical billing software experience a plusKnowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding)Ability to accurately meet required time frames/deadlinesAbility to work as a team player and share workloads with other team membersExcellent verbal and written communication skillsAbility 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
Notes:8:00am - 5:00pm
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