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



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