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GeneDX Billing Representative, Prior Authorization (FT, 40 Hours)

We are looking for a Billing Representative, Prior Authorization (40 hours per week) in our Elmwood Park, NJ location.

Schedule: Monday - Friday, 9:00am - 5:30pm

POSITION SUMMARY:

Billing Representative, Prior Authorization is responsible for requesting prior in addition to verifying insurance eligibility, recording receipt of prior authorization and following up with carriers for denials, approvals and payment. In this role, a Billing Rep will also research and communicate lab testing cost estimates to patients and clients.

PRINCIPAL JOB DUTIES:

Duties may include but are not necessarily limited to the following:

  • Requests Prior authorization from carriers through web portals
  • Requests Benefit Investigation documentation from insurance carriers
  • Educates clients office on process to initiate Prior Authorization from carriers through web portals for testing
  • Verifies insurance eligibility with various government and commercial insurance carriers
  • Follows up on Prior Authorization approvals and denials meeting timely filing requirements
  • Communicates effectively with insurance carriers
  • Ensures that patient demographics, insurance information, verification and eligibility have been established and documented
  • Maintains Excel spreadsheet with patient demographics and test data
  • Provides weekly and monthly reports on productivity to management
  • Handles inbound tickets from clients regarding cost estimates for laboratory testing
  • Makes outbound calls to payers and obtains insurance coverage information and cost estimates
  • Professionally communicates information to clients and patients
  • Clearly and concisely explains components of healthcare processes and terminology to clients and patients of all backgrounds
  • Ensures timeliness, quality and efficiency in all work to comply with mandated, legislative, and Federal requirements
  • Meets weekly and monthly productivity standards
  • Other duties as assigned

EDUCATION:

  • HS degree or equivalent

EXPERIENCE AND REQUIRED SKILLS:

  • 2-3 years of relevant experience
  • Experience using Microsoft Word and Excel or similar applications
  • Experience with insurance terminology required
  • Proficiency navigating insurance phone lines and online portals
  • Able to read and understand claims history, denials, and payments
  • Effective verbal and written communication skills
  • Ability to successfully interface with individuals at all levels, both internally and externally
  • Ability to interface with clients and patients in a professional and courteous manner
  • Excellent time management skills, great organizational skills with the ability to juggle, track, and manage all aspects of the billing process
  • Ability to work independently, as well as with a team
  • Knowledge of ICD-10 and CPT-4

 

BioReference Laboratories is an Equal Opportunity Employer



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