Patient Financial Services Associate II

About the position

Help us change lives at Exact Sciences, where we are dedicated to transforming how the world prevents, detects, and guides treatment for cancer. The Patient Financial Services Associate II (PFSAII) position plays a crucial role in ensuring the accurate and timely processing of claims, appeals, denials, and statements. This role requires a deep understanding of medical insurance, as the PFSAII will be responsible for resolving billing discrepancies, eligibility issues, denials, and appeals, as well as following up on aged unpaid claims for various types of coverage including commercial and government plans. The PFSAII will utilize Epic, external portals, and other software to communicate insurance information to ancillary departments and ensure appropriate coverage. In this position, the PFSAII will independently verify patient insurance eligibility, investigate and correct accounts within Epic, and interact with various insurances and third-party payors to ensure that authorizations are obtained and documented according to internal and external policies. The role involves researching missing or erroneous information on accounts, reviewing and editing claims and appeals prior to submission, and analyzing claim issues while applying federal, state, and payor rules and procedures. The PFSAII will also be responsible for correcting rejected claims, reviewing explanations of payments, and determining appropriate next actions for denials, including appeals or write-offs. The PFSAII will participate in team meetings to share denial trends and contribute ideas for workflow improvements to maximize performance and revenue collections. This position requires excellent problem-solving abilities, organizational skills, and the ability to communicate effectively with all levels of staff. The PFSAII must maintain strict confidentiality and adhere to HIPAA guidelines while working in a team environment. The role is remote, and the PFSAII will be expected to complete responsibilities within the appropriate time frame while adhering to quality standards.

Responsibilities
? Independently determine initial or ongoing patient insurance eligibility verification, investigate, and correct accounts within Epic.
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? Interact with various insurances and third-party payors to ensure authorization is obtained and documented.
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? Research missing or erroneous information on accounts using various portals and resources.
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? Review/edit claims and appeals prior to submitting to clearinghouse.
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? Analyze, research, and resolve claim issues applying federal, state, and payor rules and procedures.
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? Correct rejected claims from the claim's scrubber, clearinghouse, or payor.
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? Review explanations of payments and complete appropriate steps for all denials.
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? Investigate payor underpayments and follow up with payors on unpaid aging claims.
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? Provide supporting documentation needed by insurance payor.
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? Perform accurate and timely write-offs for uncollectible accounts.
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? Participate in team meetings sharing denial trends and contribute ideas for workflow improvements.
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? Complete position responsibilities within the appropriate time frame while adhering to quality standards.

Requirements
? High School Diploma or General Education Degree (GED).
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? 2 years of experience in medical billing, claims, and/or insurance processing.
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? Extensive knowledge of government, managed care, and commercial insurances claim submission requirements.
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? Knowledge of medical terminology and/or health insurance terms.
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? Knowledge of EHR operating systems and electronic records.
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? Proficient in computer systems and keyboarding skills.
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? Demonstrated strong attention to detail and focus on quality output.

Nice-to-haves
? Related Associate degree or medical billing certification.
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? 4+ years of experience in medical or insurance billing field.
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? Experience with Epic or other EHR application.

Benefits
? Dental insurance
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? Health insurance
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? Paid parental leave
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? Paid time off
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? Retirement plan
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? Vision insurance

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