Sr. Appeal Specialist (On-site)

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 114,000 colleagues serve people in more than 160 countries.

     

JOB DESCRIPTION:

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’s 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. 

 

The Opportunity 

Our location in Plano, TX currently has an opportunity for a Sr. Appeals Specialist. This role is responsible for 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. Lead efforts to develop programs that assist with multiple levels of appeal in the event of initial coverage denial. Manage complex appeals cases for assigned region including taking ownership of cases following initial denial. Forward authorized confirmation for procedure to designated patient provider. In addition, this position will take the lead on in-servicing provided to new patient providers surrounding the pre-authorization process. Act as conduit for policy and coverage training/updates to the Patient Therapy Access Specialist team by partnering with team leadership and Abbott’s Healthcare Economics & Reimbursement representatives. 

 

What You’ll Work On 

• 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 Abbott. 

• Navigate and own complex appeals process in assigned region. 

• Act as SME for all coverage policies and authorization requirements for assigned carriers. 

• Verify benefits and 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,