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Verification of Benefits Specialist
Mindlance
- 🇺🇸 United States
- On-site
- 1 month ago
- LPN
- Excel
- medical billing
- CPT
- ICD-10-CM
1 month ago
6600 Pinecrest Plano, Texas -100 percent onsite
Days/Hours: Mon – Friday 8:00am-5:00 PM
Selected Candidate will start ASAP after screenings have cleared.
Our location in Plano, TX currently has an opportunity for a Patient Therapy Access Specialist (PTA). 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 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 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
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
Verification of Benefits Specialist · Mindlance