TPIRC is a non-profit clinical care and research center that focuses on the development of cutting-edge, individualized treatment protocols for rare and orphan diseases utilizing comprehensive diagnostic tools and patient-driven research. Our treatment programs are one of a kind with unmatched success rates. Our team is rapidly growing and we are looking for a Laboratory Billing & Prior-Authorization Specialist to support our mission.
A Laboratory Billing & Prior Authorization Specialist ensures that our patients receive a prior authorization for diagnostic lab services from insurance carriers. You will receive prior authorization requests, addressing and rectifying any rejected claims while conducting the necessary third party authorization requests. This role will also help the Foundation Labs to manage insurance claims, invoices, and payments.
Duties and Responsibilities:
● Speaks to client's and patient's regarding billing, questions, and concerns
● Performs accurate, timely, and compliant data entry of medical bills
● Verifies both commercial and government insurances
● Thorough understanding of government insurances and commercial insurances
● Ability to navigate insurance websites reading EOB’S and answers customer insurance
● Assists team members with various billing tasks as needed
● Data entry on processing payments
● Work with payors on reviewing and resolving remittance errors and PA rejections
● Address billing related calls from patients and payers within a timely manner
● Submit PA Claim and appeal submissions via calls and portal lookups
● Research changes and updates to insurance plan-specific claim and appeal processes
● Assist with medical necessity documentation to expedite approvals and ensure that
appropriate follow-up is performed
● Develop and implement prior authorization workflow, policies and procedures with the
Clinical Operations Manager
● Collaborate with other departments to assist in obtaining pre-authorizations in a cross
● Review accuracy and completeness of the information requested and ensure that all
supporting documents are present.
● Receive requests for pre-authorizations and ensure that they are properly and closely
● Process referrals and submit medical records to insurance carriers to expedite prior
● Manage correspondence with insurance companies, physicians, specialists and patients
● Look through denials and submit appeals in a bid to get them approved from insurance
● Create patients’ records and accounts and ensure that pre-authorization information is
properly updated in them.
● Secure patients’ demographics and medical information by using great discretion and
ensuring that all procedures are in sync with HIPPA compliance and regulation.
● Completes special projects as needed
● Additional duties to be assigned, as needed
● Minimum of 5 years of medical billing experience, including experience in laboratory billing, required
● Proficient with Microsoft Office (Excel,Outlook, Word)
● Ability to effectively present information and respond to questions from management,
clients, auditors and internal customers.
● Working knowledge of CPT and ICD10 classifications and CPT coding guidelines
● Experience with medical billing software is preferred. Knowledge of ABN, Appeals,
EOBs, CPT AND ICD-10 coding.
● Proficient in Excel focusing on a deep knowledge of pivot tables
● Excellent communication and presentation skills.
● Clear understanding of medical industry and healthcare laboratory billing procedures
● Knowledge of HIPPA laws
● Excellent written and oral communication skills with the ability to interface with
customers and company personnel at all levels of the organization
● Must be well organized and possess a strong attention to detail
● Demonstrates excellent research, problem solving and follow up skills