You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

The Patient Financial Specialist II will be responsible for the timely completion of insurance verifications and authorizations, with a focus on genetic testing. The role requires verifying patient insurance coverage, handling insurance verification exceptions, and coordinating with vendors for prior authorizations in a high-production environment.

Responsibilities / Job Duties

• Verify insurance coverage benefits including deductible, co-insurance, and out-of-pocket maximum amounts to estimate patient costs for genetic testing
• Ensure genetic testing coverage based on CPT and ICD-10 codes and determine if authorization is required.
• Work on exceptions and rejections from automated eligibility systems.
• Submit appropriate documentation for authorization requests to the patient's insurance.
• Follow-up on authorization statuses weekly.
• Coordinate with clients and vendors to obtain necessary documentation and assist with prior authorizations.
• Identify payer websites or methods to verify insurance and submit authorization requests.
• Report on payer-related issues concerning insurance verifications and denied authorizations for process improvements.
• Collaborate with team members on beneficiary coverage issues and other assigned projects.

Minimum Education and Experience Qualification Requirements

Education

• High school diploma or equivalent

Qualifications

• Understanding of CPT codes, medical terminology, insurance plans, and ICD 10 codes.
• Excellent adaptability to a fast-paced, dynamic environment.
• Strong proficiency in computer skills.
• Comprehension of different payer plan coverage and benefit criteria.

Experience

• 1-2+ years’ experience in a clinical laboratory, preferably in genetics.
• 1-2+ years’ experience in securing prior authorization approvals.

Skills

• Technical skills in navigating insurance verification systems and platforms.
• Effective communication and problem-solving skills.

Schedule / Shift

Full remote: must work PST. Hours: 7-3:30 PST.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*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 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.

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.