WHAT YOU’LL DO

The Verification of Benefits Specialist is responsible for contacting insurance companies to verify eligibility and benefits for patients needing medical services for Mechanical Circulatory Support (MCS), Neuromodulation (NMD), CardioMems (CMEMs), and any new product lines for Continuum Services. This position will be responsible for documenting and maintaining all information related to patient’s insurance eligibility, benefits, insurance updates/changes, coordination of benefits for primary and secondary plans, as well as correspondence by and between Continuum Services and applicable payors/plans.  This position will also support submission of prior authorization requests for new and ongoing services, as well as requests for patient-specific LOA/SCAs either directly or indirectly by working with Authorization/LOA specialists.  The VOB specialist will be required to work cross-functionally to support and respond to inquiries related to insurance eligibility, benefits, insurance changes, coordination of benefits requirements, etc. from across all Continuum departments including customer service, sales, territory support, billing, and contracting.

The duties and responsibilities for this position include, but are not limited to, the following:

• Contacts insurance companies to verify eligibility and insurance benefits.
• Initiates prior-authorization requests or works with prior authorization specialists to support prior authorization requests for new and ongoing services with insurance companies and performs follow up activities to assist in obtaining prior authorization determinations.
• Files appeals for denied benefits coverage to insurance companies as needed.
• Maintains patient records in patient management / billing system.  Includes patient information related to eligibility, benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes and communications/correspondence with insurance companies.
• Updates patient insurance changes within patient management system, maintains process for verifying eligibility on regular basis for existing patients (e.g. monthly fee patients, patients with insurance plans that are month-to-month such as Medicaid and Marketplace plans, etc.).
• Coordinates and communicates with other departments as needed to obtain necessary information to complete eligibility and benefit verification, authorization, appeals and documents outcomes for services of care.
• Provides customers and patients with information that includes but is not limited to updates on status of benefits and authorizations, information on patient financial responsibility and out-of-pocket cost estimates, financial assistance options, etc. in conjunction with customer service and/or billing collections team as needed and if applicable.
• Assist in coordination of patient-specific Letters of Agreement or Single Case Agreements for non-contracted payors/plans.
• Applies knowledge of company policies and procedures, including contracted and non-contracted payor guidelines, to process patient referrals, respond to incoming inquiries and correspondence, and documents/updates patient records with relevant information, service options, care management decisions.
• Performs other related duties as assigned.

EDUCATION AND EXPERIENCE YOU’LL BRING

REQUIRED

• High School Diploma or equivalent
• A minimum of one year experience in insurance / benefits verification and/or collections and/or managed care contracting. Two or more years with direct insurance verification of eligibility and benefits preferred.
• Understand the process for verification of benefits or collections as it relates to Continuum’s policies and procedures for effective determination of services to be offered.
• Familiarity / understanding of Medicare Rules and Regulations
• MS Office experience, with an emphasis on MS Excel desired
• Good analytical, planning, organizational skills and excellent interpersonal/communication skills.
• Ability to work cross-functionally with all levels of staff.
• Outstanding communication skills, able to work effectively across boundaries and build strong working relationships with stakeholders inside (at all levels) and outside the company.
• Autonomous and a self-starter but also able to work effectively in a team environment.

PREFERRED

• Knowledge in managed care as it relates to benefits and authorizations
• Knowledge of managed care contracting, reimbursement, and fee schedules
• Strong verbal and written communication skills
• Ability to handle inbound and outbound call queues, including professional and courteous phone conversation skills that may include long hold times.
• Strong Computer/Software Skills

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:  http://www.abbottbenefits.com/pages/candidate.aspx

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.