PFS Insurance Specialist I-Front End (Monday to Friday 7am-3:30pm PST) - REMOTE (USA)

Compensation:  $22-23/hr. You are eligible to a Short-Term Incentive Plan with the target at 3% of your annual earnings, terms and conditions apply.

PFS Insurance Specialist I-Front End (REMOTE: USA)

Shift: (Monday to Friday 7am-3:30pm PST)

The Patient Financial Services (PFS) Specialist is responsible for the timely completion of the insurance verifications and/or authorizations in a high production environment. In this role the PFS Specialist must verify the patient’s insurance coverage and/or authorizations for genetic testing.

Essential Functions: 

• Verifies insurance coverage benefits including deductible, co-insurance, and out-of-pocket maximum amounts to estimate the out-of-pocket potentially owed by the patient for genetic testing
• Verifies insurance coverage for genetic testing based on CPT and ICD-10 codes and determine whether authorization is required
• Works exceptions/rejections from automated eligibility systems
• Send authorization requests for genetic testing with the appropriate documentation to the patient’s insurance
• Follow-up on authorization statuses on a weekly basis
• Contact clients for missing documentation required by the patient’s insurance
• Coordinates with other contracted vendors to assist in obtaining timely and accurate prior authorizations
• Identifies payer web sites or other methods to verify insurance coverage benefits and/or submit authorization requests
• Trends and reports payer related issues regarding insurance verifications and/or denied authorization requests for genetic testing
• Reports to other team members beneficiary coverage issues for process improvements
• Other projects as assigned

Qualifications:

• High school diploma or equivalent experience 
• Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
• Must have ability to adapt to a fast paced, dynamic environment
• Must understand different payer plans collections process
• Must have excellent computer 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
• Expert knowledge of Excel and PowerPoint for the purposes of creating reports
• Min 1 year of experience in working denials and writing appeals
  

Preferred:

• Some college preferred
• Xifin knowledge preferred
• 2+ years’ experience in a clinical laboratory preferred, especially genetic billing

#LI-AC1 #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 …