Patient Financial Services Associate I

Help us change lives

At Exact Sciences, we’re helping change how the world prevents, detects and guides treatment for cancer. We give patients and clinicians the clarity needed to make confident decisions when they matter most. Join our team to find a purpose-driven career, an inclusive culture, and robust benefits to support your life while you’re working to help others.

Position Overview

The Patient Financial Services Associate I (PFSAI) position is responsible for the accurate and timely processing of claims, appeals, denials, and statements for Exact Sciences.  A PFSAI demonstrates medical insurance knowledge by resolving billing discrepancies, eligibility, denials, appeals, and aged unpaid claim follow up for commercial, government, and plan coverage for optimal Account Receivable (AR) outcomes.  PFSAI communicates insurance information to ancillary departments and ensures appropriate coverage by utilizing Epic, external portals, and other software. Reviews and resolves payor denials, appeals, and claims with no response from the payors via portals, calls to payors, and system investigations to ensure accurate claim resolution. Reads and understands explanations of payments to resolve back end claim resolution. 

This position is remote.

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.
• 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.
• Investigate payor underpayments.
• Follow up with payors via phone on unpaid aging claims.
• Review denials and determines appropriate next actions; such as sending appeals or patient statements.
• Provide ad-hoc support, as necessary, within the department (e.g., special projects, provide support due to outages/high volume, etc.).
• Complete position responsibilities within the appropriate time frame while adhering to quality standards.
• Stay current with relevant medical billing regulations, rules, and guidelines.
• Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Excellent problem-solving abilities and organizational skills.
• Ability to communicate effectively with all levels of staff through both verbal and written communications.
• Ability to work in a team environment.
• Ability to adapt to changing workload and circumstances effectively; able to respond to new information quickly.
• Disciplined, self-motivated, and reliable.
• Ability to stay focused on a task and work independently; motivated to perform quality work.
• Diligent about arriving to work on time and completing tasks that are assigned in a timely manner.
• Conducts self in a professional manner in all interactions with members of the Exact Sc