Benefits Investigation Manager

FULGENT THERAPEUTICS LLC•Coppell, TX

13d•Onsite

About The Position

The Benefits Investigation Manager will oversee our benefits investigation and prior authorization departments. In this role, you will be responsible for ensuring patients are provided with cost estimates, financial options for testing, and ensuring all applicable testing is submitted for prior authorization. This role is accountable for authorization approvals and will partner closely with our internal Genetic Counselors, Client Services and Sales Team to ensure our clients provide records for medical necessity.

Requirements

10+ years of experience in billing, benefits investigation and/or prior authorizations.
Must have experience in prior authorizations.
7+ years of experience leading or supervising billing, benefits investigation and/or prior authorizations teams.
Bachelor’s degree in business administration, healthcare or related field; or equivalent experience
Interpersonal Skills – The ability to establish oneself as a trusted partner for counterparts; to effectively communicate and engage with all stakeholders of the organization, including physician and health system partners.
Knowledge of Revenue Cycle Management functions, including, but limited to Data Entry, ICD9 Coding, Accounts Receivable Management, and Remittance Application.
Proficient in Microsoft Office Suite, specifically Word, Excel, and Outlook, and general working knowledge of Internet for business use.
Ability to work in a fast-paced, deadline driven environment.

Nice To Haves

Preferably NGS testing.

Responsibilities

Plan, direct, and manage supervisors and staff to ensure timely, accurate, and complete processing of services while ensuring all quality and production goals are met
Tracks KPIs related to team’s performance, authorization approval rates, and denial reasons. Presents metrics to senior leadership with resolutions on how to improve overall company performance.
Works with 3rd party vendors related to benefits investigation to ensure SLAs and expectations are met.
Manage day-to-day operations and personnel in planning and facilitating efficient insurance verification services to ensure quality and customer satisfaction. (i.e., program development, process improvement, etc.)
Use experience and knowledge in end-to-end revenue cycle operations to serve as a liaison between the client and the service delivery teams.
Demonstrate the ability to understand and articulate client needs and priorities that align with benefits investigation services.
Be a SME on all billing related process aspects (including prior authorizations and benefits investigations) to the service delivery teams.
Train the service delivery teams on answering benefits investigation related questions and work with marketing to provide educational information for clients and patients.
Develop robust SOPs, processes, and training materials.
Resolve employee relations issues and recommend disciplinary action when required.
Build strategic client relationships that will lead to long-term partnerships
Other related projects and duties as assigned.