Benefits Verification Specialist

Job Description Description: Verification of Benefits Specialist 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 the 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 HS diploma required, AA a plus Has worked in a physician's office or physicians background Strong communication skills Strong organizational skills Understanding co insurance and benefit understanding 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 Top skills: Experience with insurance carriers Experience with verification of benefits and portals Proficient with computer, adobe, sales force, Microsoft office Notes: Days/Hours: Mon - Friday 8:00am-5:00 PM VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status