Compensation:
$27.00-28.00 per hour



Job Overview
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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