Lead PFS Insurance Specialist

Compensation: 

$24.00 - $30.00 per hour. You are eligible to a Short-Term Incentive Plan with the target at 5% of your annual earnings, terms and conditions apply.

Job Overview:

The Lead PFS Insurance Specialist key role is to be the subject matter expert on the entire front-end process of Patient Financial Services.

Essential Functions:

• Serves as a subject matter expert to assist PFS Specialists with any questions regarding the front-end process for Patient Financial Services
• Assists newly hired PFS Specialists for job knowledge and development to meet departmental goals and expectations
• Serves as a Client Liaison to address concerns regarding patient’s insurance coverage and ensure all documentation is obtained based on payer requirements.
• Validates appropriateness of Bill Holds and removes them based on standard operating procedures
• Performs all front end functions necessary for billing and collections:
  a. Verifies coverage benefits based on the patient’s policy to estimate the Out of Pocket cost potentially owed by the patient for genetic testing
  b. Obtains pre-authorization for products/tests from the payers based on the documentation supporting the genetic testing (e.g. Clinical Notes, Genetic Counseling,           Consent forms, ABN)
  c. Offers self-pay/financial assistance options with the patients when authorization or policy excludes coverage
• Documents all relevant actions in the patient’s case notes for audit and tracking
• Identifies payer web sites or other methods to verify insurance coverage benefits and/or submit authorization requests
• Reports to other team members beneficiary coverage issues for process improvements
• Develops expertise on all aspects of the revenue cycle to accommodate business needs
• Works exceptions/rejections from automated eligibility system
• Trends and reports payer related issues regarding insurance verifications and/or denied authorization requests for genetic testing
• Provides prompt feedback to management regarding pattern of missing and/or incomplete documentation as well as payer issues with non-covered services
• Run daily reports to ensure PFS turnaround times are met
• Other duties as assigned

Qualifications

• 1+ years’ experience in a clinical laboratory preferred, especially genetic testing
• 1+ years’ experience in obtaining approvals for prior authorizations
• High diploma or equivalent; some college a plus.
• Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
• Must have ability to adapt to a fast paced, dynamic environment
• Must understand verification and authorization requirements
• Must have excellent computer skills
• Must understand the different payer plans and good understanding of A/R
• Demonstrated customer service skills to work effectively with referral sources, the patient, health care providers, governmental agencies
• Demonstrated written, oral, and interpersonal communication skills
• Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty
• Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change
• Display a high-level of professionalism in communication both (verbal and written) and interpersonal relations

#LI-SS1 #LI-REMOTE

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 401k, 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 Opportunity Employer (EOE) and we maintain a drug-free work environment.

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