Billing Specialist

RXinsider LTD.; Lenexa (KS); On-site; USD 42,000 - 65,000; Full time

Job summary

Eurofins Transplant Genomics, LLC is seeking a Billing Specialist to verify patients’ insurance, determine financial responsibilities, and obtain prior authorizations. The role involves communicating with patients, payors, and the sales team, submitting urgent authorizations, and ensuring accurate documentation and claims submissions.

The successful candidate will manage payor websites, stay current with policy changes, and protect PHI while meeting daily and monthly production targets.

Qualifications

• Bachelor's degree or equivalent required/preferred.
• Experience verifying patients' insurance and benefits.
• Experience with prior authorization and payor websites.
• Familiarity with PHI handling and data privacy.

Responsibilities

• Verify patients’ insurance and benefits.
• Communicate patients’ responsibilities to the patient and sales team.
• Submit prior authorization requests to payor websites, fax, or phone.
• Obtain medical records or LMNs requested by insurance.
• Submit claims to insurance carriers.
• Coordinate with clients and providers to resolve issues.

Skills

Communication skills

Prioritization

Research

Attention to detail

Education

Bachelor's degree

Tools

Accounting software

Job description

Eurofins Scientific is an international life sciences company, providing a unique range of analytical testing services to clients across multiple industries, to make life and our environment safer, healthier and more sustainable. From the food you eat, to the water you drink, to the medicines you rely on, Eurofins works with the biggest companies in the world to ensure the products they supply are safe, their ingredients are authentic and labelling is accurate.

Eurofins is the global leader in food, environment, pharmaceutical and cosmetic product testing and in agroscience Contract Research Organisation services. Eurofins is one of the market leaders in certain testing and laboratory services for genomics, discovery pharmacology, forensics, advanced material sciences and in the support of clinical studies, as well as having an emerging global presence in Contract Development and Manufacturing Organisations. The Group also has a rapidly developing presence in highly specialised and molecular clinical diagnostic testing and in-vitro diagnostic products.

In over just 30 years, Eurofins has grown from one laboratory in Nantes, France to 55,000 staff across a decentralised and entrepreneurial network of 900 laboratories in over 50 countries. Eurofins offers a portfolio of over 200,000 analytical methods to evaluate the safety, identity, composition, authenticity, origin, traceability and purity of biological substances and products.

Job Description

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