Verification of Benefits Specialist

Responsibilities

• Assist with multiple levels of appeal in the event of initial coverage denial.
• Forward authorized confirmation for procedure to designated patient provider.
• Provide in-servicing to new patient providers surrounding the pre-authorization process.
• Manage 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.

Qualifications

• Associate degree in Nursing/Home Health (LVN/LPN) or related field required.
• Minimum of 2+ years 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.

Benefits

• Medical and Prescription Drug Plans
• Dental Plan
• Vision Plan
• Health Savings Account (for High-Deductible Health Plans)
• Flexible Spending Accounts (Health, Limited Purpose, Dependent Care, Commuter Parking and Commuter Transit)
• Supplemental Life Insurance
• Short Term Disability (coverage varies by state)
• Long Term Disability
• Critical Illness, Hospital coverage, Accident Insurance
• MetLife Legal, MetLife ID Fraud, and MetLife Pet Insurance
• 401(k)