The PFS Insurance Specialist’s main role is to assist the collections team towards department goals of increasing cash collections and improving reimbursement rates. The PFS Specialist should have the ability to work on any claim, regardless of aging, and must work with both commercial and government payers, and review EOB’s.
Job Responsibilities:
Works with collections team to ensure daily productivity and quality standards are met, as well as assist with training and coaching to ensure all team members are operating at full potential
Creates notes on the patients account for auditing and actions taken per the Standard Operating Procedures or as outlined by the team manager
Works the total patient accounts outstanding A/R including credits and denials to reduce A/R aging buckets per the department’s goals
Works hand in hand with the other team members to correct errors
Send corrected claims and appeals based on payer guidelines in a timely manner
Other projects as assigned
Education and Knowledge:
High school diploma plus some college preferred
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, Xifin knowledge preferred
Technical Competencies:
Must have excellent computer skills
Must understand the different payer plans and basic understanding of A/R
Must have working knowledge of MS Excel
Experience:
1-2 years’ experience in a clinical laboratory preferred, especially genetic billing
1-2 years’ experience in working denials



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