Job Description
Compensation:
$27.00-28.00 per hour
Job Overview
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.
Job Responsibilities
- 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
Job Requirements
- High school diploma or equivalent
- Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
- Must have ability to adapt to a fast paced, dynamic environment
- Must understand both verification and authorization guidance
- Must have excellent computer skills
- Must understand the different payer plans coverage and benefit criteria
- 1-2+ years’ experience in a clinical laboratory preferred, especially genetic billing
- 1-2+ years’ experience in obtaining approvals for prior authorizations
PRIVACY NOTICES
To review Ambry’s Privacy Notice, Click here: https://www.ambrygen.com/legal/privacy-policy
To review the California privacy notice, click here: California Privacy Notice | Ambry Genetics
To review the UKG privacy notice, click here: California Privacy Notice | UKG
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.