Job Summary:

The Reimbursement Specialist will be responsible for working with referring providers and/or patients to assist with preauthorization, billing, and reimbursement issues related to genetic testing, visits or consults provided by GGC.

Supervisory Responsibilities:

• May assist in training newly hired and established employees in areas related to insurance reimbursement, preauthorization, and collections.

Duties/Responsibilities:

• Perform daily activities of preauthorization submissions, billing, and auditing of accounts to ensure accurate claims submissions and optimization of reimbursement from commercial/governmental payers, clients, and payers for services provided.
• Document eligibility, benefit, and authorization information in accordance with established guidelines.
• Verify prior authorizations and/or pre-service requirements are met.
• Proactively manage and maintain all outstanding authorization accounts to increase billing of clean claims.
• Provide outstanding customer service to patients and develop and maintain positive working relationships with internal and external customers.
• Document all account activity and correspond to inquiries in a timely manner.
• Work as part of the accounts receivable operations to resolve open balances with payers.
• Escalate payer issue trends for leadership consideration along with possible solutions.
• Exhibit a good understanding of genetic services provided, as well as fee practices, with the ability to recognize areas of possible difficulty and take appropriate steps.
• Assist in resolution efforts for payers assigned within the AR department.
• Communicate and work effectively with colleagues from all departments.
• Support training of new and existing personnel specialists with tasks related to the preauthorization and reimbursement function.
• Consistently follow written and verbal communications and internal processes, as well as meet or exceed monthly quality and productivity standards.
• Perform other related duties as assigned.

Education and Experience:

• Bachelor’s degree preferred, with relevant experience in patient billing, preauthorization or insurance verification.
• Demonstrated knowledge of health insurance plans including Medicare, Medicaid, HMO’s and PPO’s beneficial.