PFS Ins Specialist I

Compensation$27.00-28.00 per hourJob OverviewThe 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 ResponsibilitiesVerifies 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 testingVerifies insurance coverage for genetic testing based on CPT and ICD-10 codes and determine whether authorization is requiredWorks exceptions/rejections from automated eligibility systemsSend authorization requests for genetic testing with the appropriate documentation to the patient’s insuranceFollow-up on authorization statuses on a weekly basisContact clients for missing documentation required by the patient’s insuranceCoordinates with other contracted vendors to assist in obtaining timely and accurate prior authorizationsIdentifies payer web sites or other methods to verify insurance coverage benefits and/or submit authorization requestsTrends and reports payer related issues regarding insurance verifications and/or denied authorization requests for genetic testingReports to other team members beneficiary coverage issues for process improvementsOther projects as assignedJob RequirementsHigh school diploma or equivalentKnowledge of CPT codes, medical terminology, insurance plans, ICD 10 codesMust have ability to adapt to a fast paced, dynamic environmentMust understand both verification and authorization guidanceMust have excellent computer skillsMust understand the different payer plans coverage and benefit criteria1-2+ years’ experience in a clinical laboratory preferred, especially genetic billing1-2+ years’ experience in obtaining approvals for prior authorizationsPRIVACY NOTICESTo review Ambry’s Privacy Notice, Click here: https://www.ambrygen.com/legal/privacy-policyTo review the California privacy notice, click here: California Privacy Notice | Ambry GeneticsTo review the UKG privacy notice, click here: California Privacy Notice | UKGEqual Opportunity EmployerThis 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.