PFS Specialist (Ins/Auth)

Job Description: Patient Financial Services (PFS) Specialist / Authorizations Rep

The Patient Financial Services (PFS) Specialist is responsible for completing insurance verifications and authorizations for genetic testing in a fast-paced environment. This role involves verifying patient insurance coverage, determining the need for authorization, and ensuring all necessary documentation is submitted to insurance companies. The PFS Specialist will handle any exceptions or rejections from automated systems, estimate patient out-of-pocket costs, and follow up on authorization statuses.

Key Responsibilities:

• Verify insurance coverage benefits, including deductibles, co-insurance, and out-of-pocket maximums, to estimate patient costs for genetic testing.
• Determine if insurance authorization is required based on CPT and ICD-10 codes.
• Work through the Xifin system to verify patient eligibility and manage exceptions by checking portals and contacting payers.
• Submit authorization requests with the appropriate documentation and follow up on their status weekly.
• Coordinate with vendors to ensure timely and accurate prior authorizations.
• Report payer-related issues and trends to improve the verification and authorization process.
• Complete additional projects as assigned.

Qualifications:

• High school diploma or equivalent.
• 2+ years of experience in insurance verification and authorizations, preferably in a clinical laboratory or genetic testing environment.
• Strong understanding of medical terminology, CPT codes, ICD-10 codes, and insurance plan coverage criteria.
• Ability to calculate deductibles, co-insurance, and out-of-pocket expenses.
• Experience with Xifin or similar systems is a plus.
• Ability to adapt to a dynamic, high-volume environment (60 accounts per day).

Schedule: Monday to Friday, 7:00 AM - 3:30 PM PST (with the possibility to start as early as 6:00 AM after training).

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.