Lead PFS Insurance Specialist

Ambry Genetics

2d•$32 - $33•Onsite

About The Position

The Lead Collector’s main role is to lead the collections team towards department goals of increasing cash collections and improving upon reimbursement rates. The Lead Collector should have the ability to work any claim, regardless of aging, and must work with both commercial and government payers, review EOB’s and medical policy to evaluate and submit for appeals, as well as perform in-depth research to appropriately obtain coverage for any denied claims. The Lead Collector will also develop and deliver reports to management to summarize payer and claims issues, and contribute suggestions for policy and process improvements; additionally, the Lead Collector will take point on implementing process changes within their team.

Requirements

High school diploma plus some college preferred
Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
Must have experience with Practice Management systems, Telcor experience preferred
Must have excellent computer skills
Must be able to coach staff and walk employees through collection processes
Must understand the different payer plans and basic understanding of A/R
Must be detail-oriented, analytical, and experienced in writing appeals
Expert knowledge of Excel and PowerPoint for the purposes of creating reports
3-5+ years’ experience in a clinical laboratory preferred, especially genetic billing
3-5+ years’ experience in working denials and writing appeals

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
Researches and understands different payer policies and reimbursement history to improve ability to successfully overturn claim denials through the claims process
Understands the various Ambry products and tests and can present reasonable arguments for medical necessity on behalf of the patient in order to obtain coverage from the insurance payer
Works hand in hand with the other team members to correct errors, communicate with team members about payer policy updates and improve work flow processes (e.g. billing integrity)
Send corrected claims and appeals based on payer guidelines in a timely manner
Manages write-offs or adjustments on accounts when applicable, as well as process refund requests received from payers to determine if payment errors were made
Develops and delivers detailed reports to management regarding overall payer issue to support denial management and works to resolve issues at both the claim and payer levels
Other projects as assigned