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.

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 ofFree medical coverage for employees* via the Health Investment Plan (HIP) PPOAn excellent retirement savings plan with high employer contributionTuition reimbursement, the Freedom 2 Save student debt program and FreeU education benefit - an affordable and convenient path to getting a bachelor’s degreeA 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 FortuneA 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

The Opportunity

Our Heart Failure solutions are helping address some of the World’s greatest healthcare challenges. The Authorization/LOA Specialist, Customer Service is responsible for contacting insurance companies to submit obtain Letters of Agreement (LOAs). This position will submit LOA requests for new and ongoing services, as well as requests for patient-specific LOA/SCAs/network exceptions/cost invoices or estimates to payors/plans and will coordinate VOB specialists to secure and communicate authorization determinations in a timely manner.  The Authorization/ LOA specialist will be responsible for appealing adverse authorization determinations and will be an advocate on behalf of Continuum Services and our patients.  This position will be responsible for documenting and maintaining all information related to patient’s LOA status in internal systems and will provide support as necessary in assessing / documenting information related to insurance eligibility, benefits, insurance updates/changes, coordination of benefits for primary and secondary plans, and any correspondence by and between Continuum Services and applicable payors/plans.  The LOA specialist will be required to work cross-functionally to support and respond to inquiries related to LOAs, insurance changes, coordination of benefits requirements, etc. from across all Continuum departments including customer service, sales, territory support, billing, and contracting.

Principle Responsibilities

The following reflects management’s definition of essential functions for this job, but does not restrict the tasks that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.

Initiates LOA requests for new and ongoing services with insurance companies for all lines of business including Commercial, Marketplace, Medicare Advantage, Managed Medicaid, State Medicaid, Other Government and Military/VA plans, etc. and performs follow up activities to ensure timely signed LOA delivery.  Is responsible for negotiating LOA rates to be within approved range from management.Develops and maintains LOA templates, correspondence, and key documentation/records/educational materials to support and include with LOA requests (e.g. LOA Template, Cost invoice template, Continuum Services marketing materials, driveline supply/sterile kits documentation/rationale, etc.)Maintains patient records in patient management / billing system.  May include patient information related to eligibility, benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes and communications/correspondence with insurance companies.Maintains and documents key learnings in regard to payor LOA requirements, contacts, billing/coding information, etc. in internal reference materials, tools, cheat sheets, as applicable.Coordinates and communicates with other departments as needed to obtain necessary information for submission of LOA requests and documents outcomes for services of care.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.Participates in cross-functional process improvement activities to streamline operational activities, liases with other Continuum departments to resolve operational issues/challenges, handles necessary ad hoc and performance reporting needs and tracking of authorization key processes and metrics, and performs other special projects and related duties as assigned.

Required Qualifications

High School Diploma or equivalent.A minimum of one year of experience in a LOA/prior authorization/insurance/benefits verification and/or collections and/or managed care contracting role. Two or more years with direct insurance verification of eligibility and benefits and LOA experience preferred.Experience navigating payor portals to support submission of prior authorization requests including Availity, Navinet, etc.Understand the process for LOAs, 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.

Preferred Qualifications

Knowledge in managed care as it relates to benefits and negotiating LOAs and ability to read and interpret managed care or state specific payor policies as they pertain to benefits, prior authorization, and contracting requirementsKnowledge of managed care contracting, reimbursement, and fee schedulesStrong verbal and written communication skillsAbility to handle inbound and outbound call queues, including professional and courteous phone conversation skills that may include long hold times.Strong Computer/Software Skills

In addition, candidates will have the following personal characteristics:

Good analytical, planning, organizational skills and excellent interpersonal/communication skills.Ability to work cross-functionally with all levels of staffOutstanding 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 and potentially in a remote role.

* Participants who complete a short wellness assessment qualify for FREE coverage in our HIP PPO medical plan. Free coverage applies in the next calendar year.

Learn more about our health and wellness benefits, which provide the security to help you and your family live full lives:  www.abbottbenefits.com

Follow your career aspirations to Abbott for diverse opportunities with a company that can help you build your future and live your best life. Abbott is an Equal Opportunity Employer, committed to employee diversity.

Connect with us at www.abbott.com, on Facebook at www.facebook.com/Abbott and on Twitter @AbbottNews and @AbbottGlobal.

The base pay for this position is $16.55 – $33.15 per hour. In specific locations, the pay range may vary from the range posted.