Verification of Benefits Specialist

Position Title:

Verification of Benefits Specialist

Work Location:

Plano, Texas

Assignment Duration: 5+ Months

Work Schedule:

Mon - Friday 8:00 AM - 5:00 PM

Work Arrangement:
Onsite

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

• HS diploma required, AA a plus Minimum of 2 plus yrs 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

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