Patient Financial Services Associate II

Role Overview

• Responsible for the accurate and timely processing of claims, appeals, denials, and statements for Exact Sciences
• Demonstrates medical insurance knowledge by resolving billing discrepancies, eligibility, denials, appeals, and aged unpaid claim follow up
• Communicates insurance information to ancillary departments and ensures appropriate coverage
• Reviews and resolves payor denials, appeals, and claims with no response from the payors
• Independently determines initial or ongoing patient insurance eligibility verification, investigates, and corrects accounts within Epic
• Ability to interact with various insurances and third-party payors accurately and timely
• Research missing or erroneous information on accounts using various portals and other resources
• Review/edit claims and appeals prior to submitting to clearinghouse
• Analyze, research, and resolve claim issues applying federal, state, and payor rules
• Correct rejected claims from the claim’s scrubber, clearinghouse, or payor
• Reviews explanations of payments and completes appropriate steps for all denials
• Investigates payor underpayments
• Follow up with payors via phone on unpaid aging claims
• Conducts self in a professional manner in all interactions with members of the Exact Sciences Clinical Laboratory team, clients, and associates

Requirements

• High School Diploma or General Education Degree (GED)
• 2 years of experience in medical billing, claims, and/or insurance processing
• Extensive and current working knowledge of government, managed care, and commercial insurances claim submission requirements, reimbursement guidelines, and denial reason codes
• Knowledge of medical terminology and/or health insurance terms
• Knowledge of EHR operating systems and work involving electronic records
• Proficient in computer systems and keyboarding skills
• Demonstrated strong attention to detail and focus on quality output
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation
• Authorization to work in the United States without sponsorship.

Benefits

• paid time off (including days for vacation, holidays, volunteering, and personal time)
• paid leave for parents and caregivers
• retirement savings plan
• wellness support
• health benefits including medical, prescription drug, dental, and vision coverage