Job Details
Description
Compensation: $24.00 - $25.00 per hour. You are eligible for a Short-Term Incentive Plan with the target at 3% of your annual earnings; terms and conditions apply.
PFS Specialist I - Front End – Remote 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 duties as assigned
Qualifications
- 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+ years of experience in obtaining approvals for prior authorizations
Preferred
- 1+ years of experience in a clinical laboratory preferred, especially genetic billing
#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. Ambry Genetics is an Equal Opportunity Employer (EOE) and we maintain a drug-free work environment.
The Company believes in second chance employment. Qualified applicants with arrest or conviction history will be considered regardless of their arrest or conviction history, consistent with local laws such as Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if the Company is concerned about conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. For the purpose of the above job description, “Essential Functions” are “Material Job Duties”.
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.
