Lead Patient Therapy Access

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 115,000 colleagues serve people in more than 160 countries.

Working at Abbott

At Abbott, you can do work that matters, grow, and learn, care for yourself and family, be your true self and live a full life. You’ll also have access to :

• Career development with an international company where you can grow the career you dream of.
• Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year.
• An excellent retirement savings plan with high employer contribution
• Tuition reimbursement, the Freedom 2 Save student debt program and FreeU education benefit - an affordable and convenient path to getting a bachelor’s degree.
• A company recognized as a great place to work in dozens of countries around the world and named one of the most admired companies in the world by Fortune.
• A company that is recognized as one of the best big companies to work for as well as a best place to work for diversity, working mothers, female executives, and scientists.
  
  

For years, Abbott’s medical device businesses have offered technologies that are faster, more effective, and less invasive. Whether it’s glucose monitoring system, innovative therapies for treating heart disease, or products that help people with chronic pain or movement disorders, our medical device technologies are designed to help people live their lives better and healthier. Every day, our technologies help more than 10,000 people have healthier hearts, improve quality of life for thousands of people living with chronic pain and movement disorders, and liberate more than 500,000 people with diabetes from routine fingersticks.

The Opportunity

Responsible for leading the efforts of the team relative to 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 as well as assisting Patient Therapy Access Specialists navigate questions, concerns and obstacles associated with standard work processing. Assist with multiple levels of appeal in the event of initial coverage denial. Forward authorized confirmation for procedure to designated patient provider. Provide regular updates to the patient and their designated provider regarding patient case status and next steps.

Main Responsibilities

• Responsible for managing multiple cases simultaneously within specific time frames.
• Assist with standard case processing as and when necessary.
• Follow all policies and procedures related to performing the job role adhering to all data use, storage and privacy policies as outlined by Abbott.
• Participate in implementing department improvement strategies and maintaining department compliance and regulatory guidelines.
• Navigate and own complex appeals process in assigned region.
• Act as front line for general questions from the team that arise on a day to day basis.
• Verify benefits, complete authorization requests promptly.
• Timely follow up for requested authorizations.
• For each procedure, audit required clinical documents for completeness and accuracy.
• Complete labeling audit to confirm case is considered to be on-label for device indications.
• 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 .
• Act as an example for compliance, correct processing, positive engagement.
• Team culture ambassador .
• Provide insight to the leadership team based on conversations and observations made on the floor.
  
  

Required Qualifications

• Associates Degree (± 13 years), In Nursing/Home Health (LVN/LPN) or related field required OR an equivalent combination of education and work experience
• Minimum 2 years, In a utilization (medical approval), payer or healthcare economics and reimbursement environment or similar work experience.
• 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 while informally leading other team members.
• Excellent communication skills; verbal and written.
• Ability to train/present concepts to others.
• Previous experience in public speaking or presenting to small groups.
• Attention to detail.
• Ability to travel 5% of the time.
• Excellent organization skills and ability to multi-task in a fast-paced environment.
  
  

The base pay for this position is $50,700.00 – $101,300.00. In specific locations, the pay range may vary from the range posted.