PFS Insurance Specialist I-Front End (Monday to Friday 9am-5:30pm EST) - 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 9am-5:30pm EST)

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
  
  

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, 401k with a 4% employer match, 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.

Our salary ranges are determined by role, level, and location. The range displayed on each job posting reflects the minimum and maximum target for new hire salaries for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training.

All qualified applicants will receive consideration for employment without regard to race (and traits historically associated with race, including, but not limited to hair texture and protective hairstyles such as braids, locks, and twists), color, creed, religion, sex, sexual orientation, gender identity, gender expression (including transgender status), national origin, ancestry, age, marital status or protected veteran status and will not be discriminated against on the basis of disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances. If you have a disability or special need that requires accommodation, please contact us at careers@ambrygen.com

Ambry does not accept unsolicited resumes from individual recruiters, third party recruiting agencies, outside recruiters or firms without an executed contract in place. We are not responsible for any fees related to resumes that are unsolicited or are received by Ambry. Such resumes will be deemed the sole property of Ambry and will be processed accordingly.

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