Verification of Benefits Specialist

As a PTA Specialist you are responsible for facilitating and assisting 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 the 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

HS diploma required, AA a plus
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:
100% Onsite
Mon – Friday 8:00am-5:00 PM