Billing Specialist

Basic Function and Scope of Responsibility: 

Eurofins Transplant Genomics, LLC (ETG) is a molecular diagnostics company committed to improving organ transplant outcomes with non-invasive serial monitoring guided by biomarkers. ETG’s product portfolio of individual and combined whole blood gene expression and donor derived cell-free DNA testing can reliably rule out subclinical kidney rejection and acute rejection in kidney transplant patients. In addition to kidney transplantation testing, our newest product for liver transplant patients is a blood-based biomarker assay designed to rule out rejection as immunosuppression therapy is optimized.   

The Billing Specialist effectively communicates the estimated financial responsibility of the member and obtains prior authorization for billing. To achieve this, the Specialist is responsible for verifying the receipt of test order IDs, checking the member's insurance and benefits, communicating the member's financial responsibilities to the patient and/or sales team, submitting prior authorization requests through payor websites, fax or phone, and procuring medical records or documentation as required by insurance prior authorization or appeals. They must also keep up to date with changes in insurance policies and pre-certification requirements and maintain current knowledge of payor websites and utilization. Entering payor and responsible party information accurately into the accounting system is crucial. The Specialist must also possess exceptional task prioritization skills and the ability to review tasks efficiently and thoroughly. Research is also a crucial aspect of this role, which may require follow up and appeal of prior authorization rejections/denials. This role also includes monitoring FAP's.

Essential Job Duties:

• Verify patients’ insurance and benefits.
• Communicate patients’ responsibilities.
• Notify management of identified trends as needed, and at month-end, arrange payment plans.
• Enroll patients in Financial Assistance Programs.
• Submit prior authorization requests to payor websites, fax, or phone.
• Obtain medical records or LMNs that the insurance company requests for prior authorization and billing.
• Submit electronic and paper claims to insurance carriers.
• If the patient declines, complete a cancellation form or offer payment options.
• Communicate with clients.
• Offer prompt pay discounts, arrange payment plans, and provide financial assistance as needed.
• Meet daily and monthly departmental productivity goals set by management to achieve the company's financial goals.
• Ensure completion and recording of documentation.
• Be responsible for protecting, securing, and properly handling all PHI (Protected Health Information).
• Research, review, and communicate with insurance carriers regarding open accounts receivable.
• Prepare and submit appeals.
• Timely management of unpaid claims.
• Coordinate the release of medical information to insurance companies, lawyers, state, and federal agencies.
• Meet all audit requests within the allotted time frame.
• Correct claim errors and coordinate, monitor, and manage the follow-up on unpaid claims in a timely manner.
• Collaborate with healthcare providers to resolve pre-certification issues and ensure the timely delivery of medical services.
• Responsible for the timely accurate submission of all prior authorizations for service to the responsible payer.
• Communicate with insurance companies and healthcare providers and review medical records and documentation to ensure compliance with pre-certification requirements.
• Ensure that all payers needing prior authorization are set up correctly within the software system.
• Communicate with private practice, facility, and nursing home clients regarding medical record needs.
• Handle difficult situations involving patients, physicians, or others in a professional manner.
• Perform other duties as assigned and have flexibility to be cross trained to meet departmental needs. 
• Maintain accurate and up-to-date records of pre-certification approvals and denials with confidence.
• Attend meetings for updates, communications, and learning opportunities.
• Maintain a good working relationship within the department, with clients, insurance carriers, and other departments. 
• Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
• Performs pre-service authorization reviews to obtain payment authorization for outpatient services. 
• Succinctly abstracts fact-based clinical information to support pre-authorization utilizing applicable nationally recognized and payer-specific criteria; communicates the clinical information in a timely manner supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task.
• Perform other duties as assigned.

Level I BS – Minimum Requirements:

• Compile, process, and maintain patient files to handle storage and retention of clinicals.

Level II BS – Minimum Requirements:

• Demonstrate effective teamwork skills by knowledge-sharing
• Participate on special project teams as requested by supervisory staff

Level III BS – Minimum Requirements:

• Obtain advanced knowledge of standard operating procedures
• Participate in troubleshooting activities in conjunction with the Supervisor/Manager
• Recommends and assist with implementing process improvements.

Level Lead – Minimum Requirements:

• Effectively supervise the billing/Pre-Authorization, providing expert guidance and unwavering support as needed.
• Proactively conduct regular audits of billing processes to identify areas for improvement and implement innovative solutions.
• Proactively Assist with complex special projects, escalate high-level billing issues to management, and perform other duties as assigned.
• Creating/scheduling/analyzing billing reports for the department to identify patterns/issues that could have a financial impact (including monitoring write-offs submitted by the department)
• Take on formally assigned additional duties, such as training, as a part of routine job performance

Essential Experience, Knowledge, Skills and Abilities:

• Excellent customer service skills, with a focus on professionalism
• Ability to solve problems, prioritize tasks, and multitask effectively
• Goal-oriented mindset with excellent time management and organizational skills
• Strong interpersonal communication skills, including the ability to interact efficiently with individuals at all levels in an organization
• Strong level of empathy & patience
• Excellent verbal and written communication skills
• Attention to detail, accuracy, and time management
• Proficiency in PC-based software such as Microsoft Excel, Teams, iPhone, Adobe, and associated applications
• A fundamental understanding of medical billing concepts
• Knowledge of Medicare, Medicaid, and commercial insurance
• Familiarity with HIPAA (Health Insurance Portability and Accountability) privacy requirements
• Knowledge of Availity and eligibility portals and medical terminology
• Follow up on missing or incorrect information so patients receive the right reimbursement.
• Document account activity using correct medical and billing codes.
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
• Be investigative to find necessary information, if needed
• Ability to handle multiple priorities and meet deadlines
• Ability to work independently and as part of a team in a fast-paced environment
• Demonstration of self-motivation and ownership of assigned work
• A high level of professionalism and confidentiality in handling sensitive information is imperative. 
• Ability to self-start and work independently as well as respond to STAT requests in a timely manner
• Excellent verbal & written communication skills.
• Analytical judgment, problem-solving skills, accuracy, and strong orientation.
• Bilingual experience a plus.

BS I – Minimum:

• A high school diploma, GED, or equivalent education
• A minimum of 1 year of experience in billing with knowledge of EOBs, deductibles, and co-pays
• 1 year of client and operational experience in diagnostics, specifically within a medical facility or lab environment, preferred.

BS II – Fully meets the qualifications of Level I plus the following:

• A minimum of 2 years' experience in billing with knowledge of EOBs (Explanation of Benefits), deductibles, and co-pays is required.
• A minimum of 2 years Xifin experience.
• A minimum of 2 years' client and operational experience in diagnostics is preferred.

BS III – Fully meets the qualifications of Level II plus the following:

• A minimum of 4 years' client and operational experience in diagnostics is preferred.
• A minimum of 4 years Xifin experience.
• A minimum of 4 years' experience in billing with knowledge of EOBs (Explanation of Benefits), deductibles, and co-pays is required.

BS Lead – Fully meets the qualifications of Level III plus the following:

• A minimum of 7 years' strong knowledge and experience in billing with EOBs (Explanation of Benefits), deductibles, and co-pays is required.
• A minimum of 4 years Xifin experience.
• A minimum of 7 years' client and operational experience in diagnostics is preferred.
• Pull reports through for workflow and production evaluation auditing.

Physical Requirements:

• Physical dexterity sufficient to use hands, arms, and shoulders repetitively to operate a keyboard and other office equipment, use a telephone, access file cabinets and other items stored at various levels, including overhead. 
• Ability to speak and hear well enough to communicate clearly and understandably with sufficient volume to ensure an accurate exchange of information in normal conversational distance, over the telephone, and in a group setting. 
• Ability to continuously operate a personal computer for extended periods of time (4 or more hours) 
• Mental acuity sufficient to collect and interpret data, evaluate, reason, define problems, establish facts, draw valid conclusions, make valid judgments and decisions. 
• Ability to travel (as needed)

The essential physical and mental requirements described here are representative of those that must be met by an employee to successfully perform the job's essential functions.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

What we offer:

• Excellent full time benefits including comprehensive medical coverage, dental, and vision options
• Life and disability insurance
• 401(k) with company match
• Paid vacation and holidays

Eurofins USA Clinical Diagnostics is a Disabled and Veteran Equal Employment Opportunity employer.