Abbott
Prior Authorization Associate I
About this role
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 122,000 colleagues serve people in more than 160 countries.JOB DESCRIPTION: The Prior Authorization Associate Level I is responsible for all aspects of the prior authorization process. The individual will be expected to work cross-functionally across many departments (sales, operations, billing, and lab teams) to serve our patient and client needs. This role will demonstrate knowledge by determining initial and/or ongoing eligibility, coverage in addition to assessing if a prior authorization is needed for reimbursement of a claim. This role will identify deficiencies within the Prior Auth process, assist with triaging, and document actions taken within the systems. This role will be responsible for the working accounts held within the dedicated work queues on a daily basis. This role will also support the broader activities of ensuring appropriate coverage by utilizing Epic, external portals, and other software, and communicate all applicable information to ancillary departments and other teams within the reimbursement operations departments. Shift: 1st, 8am-5pm Monday
- Friday Essential Duties Include, but are not limited to, the following:
- Independently determine initial or ongoing patient insurance eligibility verification, investigate, and correct accounts within Epic; including updates to patient demographics, financial information, and guarantor information.
- Ability to interact with various insurances and third-party payors accurately and timely to ensure authorization is obtained and documented based on internal and external policies and regulations.
- Research missing or erroneous information on accounts using various portals and other resources; including outreach and identification of unknown payors.
- Review/edit claims and appeals prior to submitting to clearinghouse.
- Analyze, research, and resolve claim issues applying federal, state, and payor rules and procedures with a high degree of independence.
- Monitor WQ’s for claims that need additional research and actions taken to get on to path of resolution.
- Responsible for CRM support.
- Has exceptional understanding of Claim Edit and Follow Up WQs.
- Utilize Onbase to work documents specific to the TOQ department.
- Correct rejected claims from the claim’s scrubber, clearinghouse, or payor.
- Review explanations of payments, analyzes, and completes appropriate steps for all denials by appropriately identifying claim resolution next steps; including appealing, writing off, or sending statements.
- Validate new workflows due to product growth. Additionally, have ownership of the specific WQ’s until set up is validated as working effectively.
Preferred Qualifications
- Related Associate degree or medical billing certification.
- 5+ years of experience in medical, laboratory or insurance billing fields.
- Experience with Epic or other EHR application. The base pay for this position is $14.85 – $29.65/hourIn specific locations, the pay range may vary from the range posted. JOB FAMILY: Accounts Payable & Receivables, Credit & Collection, & PayrollDIVISION: ONCO Cancer DiagnosticsLOCATION: United States of America : RemoteADDITIONAL LOCATIONS: WORK SHIFT: StandardTRAVEL: Yes, 5 % of the TimeMEDICAL SURVEILLANCE: NoSIGNIFICANT WORK ACTIVITIES: Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day), Keyboard use (greater or equal to 50% of the workday)Abbott is an Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans.EEO is the Law link
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