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PFS Specialist

Company: Ambry Genetics
Location: Aliso Viejo
Posted on: May 4, 2020

Job Description:

Position Summary:

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.

Position Requirements:


  • 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

    Position 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

      About Us:

      Ambry Genetics Corporation is a CAP-accredited and CLIA-licensed molecular genetics laboratory based in Aliso Viejo, California. We are a genetics-based healthcare company that is dedicated to open scientific exchange so we can work together to understand and treat all human disease faster.

      At Ambry, everyone is welcome. A career at Ambry Genetics is a chance to be part of a dynamic company that aims to improve health by understanding the relationships between genetics and human disease. We earned our reputation as industry leaders by responsibly introducing cutting-edge genetic testing solutions and continually sharing what we learn with the global scientific community. We also support those with genetic conditions through the Mauli Ola Foundation and other nonprofit organizations. At Ambry you will be learning, challenging yourself, and having fun while collaborating with teammates through the open exchange of ideas.

      Employees at Ambry Genetics have many perks, including an onsite caf-- with complimentary smoothies and infused waters! We also offer access to gym memberships, onsite food trucks,"Lunch and Learns," Pajama Days, Chili Cook-Offs and more. Our outstanding benefits program includes medical, dental, vision, 401k, FSA, generous paid time off (PTO) program, and flexible scheduling as determined appropriate. Ambry Genetics is an Equal Opportunity Employer (EOE) and we maintain a drug-free work environment.

      Ambry Genetics is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

Keywords: Ambry Genetics, Aliso Viejo , PFS Specialist, Other , Aliso Viejo, California

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