LivaNova, PLC
Case Manager: Prior Authorization - REMOTE
LivaNova, PLC, Houston, Texas, United States, 77246
Join us today and make a difference in people's lives!
LivaNova is a global medical technology company built on nearly five decades of experience and a relentless commitment to improving the lives of patients around the world. Our advanced technologies and breakthrough treatments provide meaningful solutions for the benefit of patients, healthcare professionals, and healthcare systems. The company is listed on the NASDAQ stock exchange under the ticker symbol " LIVN ." LivaNova is headquartered in London (UK) with a presence in over 100 countries and a team of more than 3,000 employees worldwide.
LivaNova Neuromodulation:
As pioneers of the VNS (Vagus Nerve Stimulation) Therapy® system, LivaNova continues to advance medical device solutions for patients affected by Drug-Resistant Epilepsy (DRE) and Difficult-to-Treat Depression (DTD). There are 3 million people in the U.S. alone and one on three people with epilepsy are drug resistant. People with severe seizures have, on average, a shorter life expectancy and an increased risk of cognitive impairment particularly if the seizures developed in early childhood. VNS Therapy for DRE is delivered through a device that sends mild pulses to the vagus nerve at regular intervals throughout the day in an effort to prevent seizures
The
PACM
is primarily responsible for the coordination and implementation of the financial (insurance) approval aspect for individuals referred by their treating physicians for vagus nerve stimulation surgery.
The process is initiated by the PACM following receipt of a physician signed patient identification and qualification (PIQ) form as well as a referral from the territory case manager (assigned to the particular patient).
The PACM is responsible for completion of payer required forms and medical necessity letter (when required) and payer submission (per payer requirements).
In the event a payer requires submission by service provider via payer portal, PACM will assist service provider according to provider preference.
The PACM is responsible for payer follow-up specific to submitted authorizations and updating database appropriately. This role maintains communication with others involved in the verification and care coordination process, including but not limited to the territory Case Manager, Verification Specialist & Reimbursement Specialist. Prior Authorization Case Managers (PACMs) collaborate) to ensure that authorization needs are met within an acceptable timeframe.
The PACM reports to the Case Management Manager.
Primary ActivitiesServes as a resource to other members of the PACM team, providing guidance specific to insurance/payer issues and authorization submissions and follow-up (Team Leader)Reviews clinical documentation and determines completeness of clinical notes and prior workup documentationCoordinates with territory case manager to fill gaps in clinical notes and obtain prior workup documentationCompletes and submits VNS surgery authorization requests to health care plan(s) as requested by the health care provider (including payer specific forms)Provides draft letter of medical necessity to physician provider upon requestCommunicates with payer(s)/health care plan(s) for status update of previously submitted authorization requestsAssists with payor appeals process to achieve approval or until appeal options are exhausted in the event of a prior authorization request denialServes as resource to physician providers as well as other LivaNova team members specific to the authorization processAssists physicians and hospitals with pre-surgical reimbursement coding and denial appeals as neededAdditional Activities
Attends local, regional or national meetings, educational seminars & symposia as requiredCollaborates with other PACM team members to identify changes in payer policies specific to VNS surgery authorizations as well as any payer specific trends in authorization processing; and works with other team members in developing strategies to address any negative trendsEducates physicians and case managers on appropriate clinical documentation needed to support the prior authorization processPerforms other duties as required by managementMaintains current training as required by LivaNova and the Case Management DepartmentMinimum Requirements and Qualifications
Bachelor of Science or Vocational/Practical degree in Nursing (LVN-LPN); or Master's prepared Social Worker.5+ years of experience and understanding in coding and billing, prior authorization, patient education, and coordination of care. (preferably with Neurology, Mental Health, Cardiac, Cardiac Surgery, Neurosurgery within a practice or facility),Exceptional written, telephonic, and verbal communication skills, with internal and external customers at all levelsFamiliarity with various software/programs, including Word, Excel, PowerPoint, Microsoft Outlook & Microsoft One NoteSkills
Good organizational skills with the ability to multi-task and prioritizeAbility to work independently; self-starter with results orientationExcellent interpersonal skills with evidence of teamwork and collaborationDemonstrated commitment to the LivaNova mission
Pay Transparency:
A reasonable estimate of the annual base salary for this position is $70,000- $80,000 + discretionary annual bonus. Pay ranges may vary by location.
Our commitment to Diversity & Inclusion:
LivaNova values equality and celebrates diversity. We are committed to ensuring that our recruitment process is fair, transparent and free from unlawful discrimination.
Our selection process is driven by the key demands/requirements for the role rather than bias or discrimination on the basis of a candidate's sex, gender identity, age, marital status, veteran status, non-job-related disability/handicap or medical condition, family status, sexual orientation, religion, color, ethnicity, race or any other legally protected classification.
Notice to third party agencies:
Please note that we do not accept unsolicited resumes from recruiters or employment agencies. In the absence of a signed Recruitment Services Agreement, we will not consider, or agree to, payment of any referral compensation or recruiter fee. In the event that a recruiter or agency submits a resume or candidate without a previously signed agreement, we explicitly reserve the right to pursue and hire those candidate(s) without any financial obligation to the recruiter or agency.
Beware of Job Scams:
Please beware of potentially fraudulent job postings or suspicious recruiting activity by persons posing as LivaNova recruiters or employees. The scammers may attempt to solicit confidential, personal information, such as a social security number, or your financial information. LivaNova will never ask for fees prior/during/after the application process, nor will we ask for banking details or personal financial information in return for the assurance of employment. If you are concerned that an offer of employment might be a scam or that the recruiter is not legitimate, please verify by searching for "See Open Jobs" on https://www.livanova.com/en-us/careers, and check that all recruitment emails come from an @livanova.com email address.
LivaNova is a global medical technology company built on nearly five decades of experience and a relentless commitment to improving the lives of patients around the world. Our advanced technologies and breakthrough treatments provide meaningful solutions for the benefit of patients, healthcare professionals, and healthcare systems. The company is listed on the NASDAQ stock exchange under the ticker symbol " LIVN ." LivaNova is headquartered in London (UK) with a presence in over 100 countries and a team of more than 3,000 employees worldwide.
LivaNova Neuromodulation:
As pioneers of the VNS (Vagus Nerve Stimulation) Therapy® system, LivaNova continues to advance medical device solutions for patients affected by Drug-Resistant Epilepsy (DRE) and Difficult-to-Treat Depression (DTD). There are 3 million people in the U.S. alone and one on three people with epilepsy are drug resistant. People with severe seizures have, on average, a shorter life expectancy and an increased risk of cognitive impairment particularly if the seizures developed in early childhood. VNS Therapy for DRE is delivered through a device that sends mild pulses to the vagus nerve at regular intervals throughout the day in an effort to prevent seizures
The
PACM
is primarily responsible for the coordination and implementation of the financial (insurance) approval aspect for individuals referred by their treating physicians for vagus nerve stimulation surgery.
The process is initiated by the PACM following receipt of a physician signed patient identification and qualification (PIQ) form as well as a referral from the territory case manager (assigned to the particular patient).
The PACM is responsible for completion of payer required forms and medical necessity letter (when required) and payer submission (per payer requirements).
In the event a payer requires submission by service provider via payer portal, PACM will assist service provider according to provider preference.
The PACM is responsible for payer follow-up specific to submitted authorizations and updating database appropriately. This role maintains communication with others involved in the verification and care coordination process, including but not limited to the territory Case Manager, Verification Specialist & Reimbursement Specialist. Prior Authorization Case Managers (PACMs) collaborate) to ensure that authorization needs are met within an acceptable timeframe.
The PACM reports to the Case Management Manager.
Primary ActivitiesServes as a resource to other members of the PACM team, providing guidance specific to insurance/payer issues and authorization submissions and follow-up (Team Leader)Reviews clinical documentation and determines completeness of clinical notes and prior workup documentationCoordinates with territory case manager to fill gaps in clinical notes and obtain prior workup documentationCompletes and submits VNS surgery authorization requests to health care plan(s) as requested by the health care provider (including payer specific forms)Provides draft letter of medical necessity to physician provider upon requestCommunicates with payer(s)/health care plan(s) for status update of previously submitted authorization requestsAssists with payor appeals process to achieve approval or until appeal options are exhausted in the event of a prior authorization request denialServes as resource to physician providers as well as other LivaNova team members specific to the authorization processAssists physicians and hospitals with pre-surgical reimbursement coding and denial appeals as neededAdditional Activities
Attends local, regional or national meetings, educational seminars & symposia as requiredCollaborates with other PACM team members to identify changes in payer policies specific to VNS surgery authorizations as well as any payer specific trends in authorization processing; and works with other team members in developing strategies to address any negative trendsEducates physicians and case managers on appropriate clinical documentation needed to support the prior authorization processPerforms other duties as required by managementMaintains current training as required by LivaNova and the Case Management DepartmentMinimum Requirements and Qualifications
Bachelor of Science or Vocational/Practical degree in Nursing (LVN-LPN); or Master's prepared Social Worker.5+ years of experience and understanding in coding and billing, prior authorization, patient education, and coordination of care. (preferably with Neurology, Mental Health, Cardiac, Cardiac Surgery, Neurosurgery within a practice or facility),Exceptional written, telephonic, and verbal communication skills, with internal and external customers at all levelsFamiliarity with various software/programs, including Word, Excel, PowerPoint, Microsoft Outlook & Microsoft One NoteSkills
Good organizational skills with the ability to multi-task and prioritizeAbility to work independently; self-starter with results orientationExcellent interpersonal skills with evidence of teamwork and collaborationDemonstrated commitment to the LivaNova mission
Pay Transparency:
A reasonable estimate of the annual base salary for this position is $70,000- $80,000 + discretionary annual bonus. Pay ranges may vary by location.
Our commitment to Diversity & Inclusion:
LivaNova values equality and celebrates diversity. We are committed to ensuring that our recruitment process is fair, transparent and free from unlawful discrimination.
Our selection process is driven by the key demands/requirements for the role rather than bias or discrimination on the basis of a candidate's sex, gender identity, age, marital status, veteran status, non-job-related disability/handicap or medical condition, family status, sexual orientation, religion, color, ethnicity, race or any other legally protected classification.
Notice to third party agencies:
Please note that we do not accept unsolicited resumes from recruiters or employment agencies. In the absence of a signed Recruitment Services Agreement, we will not consider, or agree to, payment of any referral compensation or recruiter fee. In the event that a recruiter or agency submits a resume or candidate without a previously signed agreement, we explicitly reserve the right to pursue and hire those candidate(s) without any financial obligation to the recruiter or agency.
Beware of Job Scams:
Please beware of potentially fraudulent job postings or suspicious recruiting activity by persons posing as LivaNova recruiters or employees. The scammers may attempt to solicit confidential, personal information, such as a social security number, or your financial information. LivaNova will never ask for fees prior/during/after the application process, nor will we ask for banking details or personal financial information in return for the assurance of employment. If you are concerned that an offer of employment might be a scam or that the recruiter is not legitimate, please verify by searching for "See Open Jobs" on https://www.livanova.com/en-us/careers, and check that all recruitment emails come from an @livanova.com email address.