Sr. Appeals Specialist

Abbott Laboratories Plano , TX 75023

Posted 6 days ago

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 107,000 colleagues serve people in more than 160 countries

Our location in Plano, TX currently has an opportunity for a Sr. Appeals Specialist. This role is responsible for facilitating and assisting Abbott patients with the pre-certification, determination and authorization process necessary as a prerequisite to perform various procedures or forms of therapy based on physician recommendation. Lead efforts to develop programs that assist with multiple levels of appeal in the event of initial coverage denial. Manage complex appeals cases for assigned region including taking ownership of cases following initial denial. Forward authorized confirmation for procedure to designated patient provider. In addition, this position will take the lead on in-servicing provided to new patient providers surrounding the pre-authorization process. Act as conduit for policy and coverage training/updates to the Patient Therapy Access Specialist team by partnering with team leadership and Abbott's Healthcare Economics & Reimbursement representatives.

WHAT YOU'LL DO

  • 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 Abbott

  • Navigate and own complex appeals process in assigned region

  • Act as SME for all coverage policies and authorization requirements for assigned carriers

  • 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 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

  • Minimum of 3 plus yrs experience in a utilization (medical approval), payer or healthcare economics and reimbursement environment or similar work experience

  • Bachelor's degree in Nursing/Home Health (LVN/LPN) or related field required.

  • General 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 communication skills; verbal and written

  • Ability to train/present concepts to others

Preferred

  • Self-disciplined to work in home office setting (outside corporate office)

  • Previous experience in public speaking or presenting to small groups

  • Ability to travel 5% of the time

  • Excellent organization skills and ability to multi-task in a fast-paced environment

  • Ability to accurately meet required time frames/deadlines

  • Ability to work as a team player and share workloads with other team members

  • Excellent communication skills; verbal and written

  • Ability to train/present concepts to others

WHAT WE OFFER

At Abbott, you can have a good job that can grow into a great career. We offer:

  • Training and career development, with onboarding programs for new employees and tuition assistance

  • Financial security through competitive compensation, incentives and retirement plans

  • Health care and well-being programs including medical, dental, vision, wellness and occupational health programs

  • Paid time off

  • 401(k) retirement savings with a generous company match

  • The stability of a company with a record of strong financial performance and history of being actively involved in local communities

Learn more about our benefits that add real value to your life to help you live fully: www.abbottbenefits.com

Follow your career aspirations to Abbott for diverse opportunities with a company that provides the growth and strength to build your future. Abbott is an Equal Opportunity Employer, committed to employee diversity.

Connect with us at www.abbott.com, on Facebook at www.facebook.com/Abbott and on Twitter @AbbottNews and @AbbottGlobal

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Sr. Appeals Specialist

Abbott Laboratories