Patient Biller

Patient Benefits Specialist

Inform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology.

Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform.

Our Specialist will interact with patients, insurance carriers, medical facilities, and providers on a daily basis to ensure a seamless front-end benefits verification, coordination and authorization process for all tests. Our Specialist is responsible for providing excellent service by responding to questions from patients, clerical staff, and insurance companies, as well as identifying and resolving patient billing complaints. The Patient Benefits Specialist will review accounts for billing accuracy in order to maximize reimbursement. The Patient Benefits Specialist will have strong attention to detail with the aptitude to learn our medical billing and collections process specifically eligibility verification and prior authorization processes. Our Specialist is responsible to work, research, and resolve front end errors. The mission of the Specialist is to provide excellent customer service and performs a wide variety of complex patient benefits investigation, coordination, and billing duties.

Key Job Elements

• Communicates with various regional and national payers, including Federal, State, Third Party (HMO,PPO, IPA, TPA Indemnity) to validate health plan eligibility, benefits, deductibles and maintains accurate documentation.
• Serves as the point of contact for patients to ensure accurate communication of health plan benefits and eligibility and answers all patient concerns regarding coverage and billing details.
• Coordinates all patient and insurance billing for the medical laboratory; ensures that patient information is entered accurately, verify patient insurance eligibility and benefits, submit prior authorizations and submit clean claims to insurance companies on a daily basis.
• Reviews physician referrals for completeness and accuracy ensuring the referral includes patient information, diagnosis code, type of service, physician signature, date and authorization number is required. Faxes referral to referring physician if information is incomplete.

Knowledge/Experience

• High School Diploma; Associate's/Bachelor's degree or equivalent experience preferred.
• Medical Certification is highly desirable.
• 1-3 years of Customer Service experience in the health industry.
• 1-3 years of work experience in Medical Billing and Coding.
• 1-3 years of work experience in high call volume setting with insurance and patients.
• Knowledge of and experience with CPT-4 and ICD-9 and HCPC billing, coding and posting charges in medical billing software.
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Knowledge of insurance plan benefits and terminology.
• Knowledge of and experience with contract payer policies and procedures.
• Knowledge of HIPPA compliance.

Additional Skills

• Proficient in Microsoft Office Suite applications.

Environment

Fulgent Therapeutics LLC is an Equal Employment Opportunity Employer. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term "qualified individual with a disability" means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position.