PFS Lead Back End-Remote, USA

Compensation:  $28 - $30 per hour. You are eligible for a Short-Term Incentive with the target at 5% of your annual earnings; terms and conditions apply.

PFS Lead Back End-Remote, USA

The Lead Collector’s main role is to lead the collections team towards department goals of increasing cash collections and improving upon reimbursement rates. The Lead Collector should have the ability to work any claim, regardless of aging, and must work with both commercial and government payers, review EOB’s and medical policy to evaluate and submit for appeals, as well as perform in-depth research to appropriately obtain coverage for any denied claims. The Lead Collector will also develop and deliver reports to management to summarize payer and claims issues, and contribute suggestions for policy and process improvements; additionally, the Lead Collector will take point on implementing process changes within their team.

Essential Function

• Works with collections team to ensure daily productivity and quality standards are met, as well as assist with training and coaching to ensure all team members are operating at full potential
• Creates notes on the patients account for auditing and actions taken per the Standard Operating Procedures or as outlined by the team manager
• Works the total patient accounts outstanding A/R including credits and denials to reduce A/R aging buckets per the department’s goals
• Researches and understands different payer policies and reimbursement history to improve ability to successfully overturn claim denials through the claims process
• Understands the various Ambry products and tests and can present reasonable arguments for medical necessity on behalf of the patient in order to obtain coverage from the insurance payer
• Works hand in hand with the other team members to correct errors, communicate with team members about payer policy updates and improve work flow processes (e.g. billing integrity)
• Send corrected claims and appeals based on payer guidelines in a timely manner
• Manages write-offs or adjustments on accounts when applicable, as well as process refund requests received from payers to determine if payment errors were made
• Develops and delivers detailed reports to management regarding overall payer issue to support denial management and works to resolve issues at both the claim and payer levels
• Other duties as assigned

Qualifications 

• High school diploma plus some college preferred
• Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
• Must have ability to adapt to a fast paced, dynamic environment
• Must have experience with Practice Management systems, Telcor experience preferred
• Must have excellent computer skills
• Must have leadership skills
• Must be able to coach staff and walk employees through collection processes
• Must understand the different payer plans and basic understanding of A/R
• Must be detail-oriented, analytical, and experienced in writing appeals
• Expert knowledge of Excel and PowerPoint for the purposes of creating reports
• 3+ years’ experience in a clinical laboratory preferred, especially genetic billing
• 3+ years’ experience in working denials and writing appeals

About Us: 

Ambry Genetics Corporation is a CAP-accredited and CLIA-licensed molecular genetics laboratory based in Aliso Viejo, California. We are a genetics-based healthcare company that is dedicated to open scientific exchange so we can work together to understand and treat all human disease faster.

At Ambry, everyone is welcome. A career at Ambry Genetics is a chance to be part of a dynamic company that aims to improve health by understanding the relationships between genetics and human disease. We earned our reputation as industry leaders by responsibly introducing cutting-edge genetic testing solutions and continually sharing what we learn with the global scientific community.

At Ambry you will be learning, challenging yourself, and having fun while collaborating with teammates through the open exchange of ideas.  Our outstanding benefits program includes medical, dental, vision, FSA, paid sick leave and generous paid time off (PTO) program. You can learn more about the benefits here. Ambry Genetics is an Equal O