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.

* 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

* Responsible for managing multiple cases simultaneously within specific time frames

* Follow all policies and procedures related to performing the job role

* Verify benefits, complete authorization requests promptly

* Timely follow up for requested authorizations

* 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 utilization review departments to obtain appropriate authorizations

* Process appeals for denied requests within established guidelines

* Train patients and designated providers on pre-authorization processes and requirements

* Work individually and in a team environment to educate assigned Field Territory Managers and Clinical Specialists

* Associate degree in Nursing/Home Health (LVN/LPN) or related field required

* Minimum of 2 plus 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