Patient Financial Services Associate II

Job Description: • Responsible for the accurate and timely processing of claims, appeals, denials, and statements for Exact Sciences • Demonstrates medical insurance knowledge by resolving billing discrepancies, eligibility, denials, appeals, and aged unpaid claim follow up • Communicates insurance information to ancillary departments and ensures appropriate coverage • Reviews and resolves payor denials, appeals, and claims with no response from the payors • Independently determines initial or ongoing patient insurance eligibility verification, investigates, and corrects accounts within Epic • Ability to interact with various insurances and third-party payors accurately and timely • Research missing or erroneous information on accounts using various portals and other resources • Review/edit claims and appeals prior to submitting to clearinghouse • Analyze, research, and resolve claim issues applying federal, state, and payor rules • Correct rejected claims from the claim’s scrubber, clearinghouse, or payor • Reviews explanations of payments and completes appropriate steps for all denials • Investigates payor underpayments • Follow up with payors via phone on unpaid aging claims • Conducts self in a professional manner in all interactions with members of the Exact Sciences Clinical Laboratory team, clients, and associates Requirements: • High School Diploma or General Education Degree (GED) • 2 years of experience in medical billing, claims, and/or insurance processing • Extensive and current working knowledge of government, managed care, and commercial insurances claim submission requirements, reimbursement guidelines, and denial reason codes • Knowledge of medical terminology and/or health insurance terms • Knowledge of EHR operating systems and work involving electronic records • Proficient in computer systems and keyboarding skills • Demonstrated strong attention to detail and focus on quality output • Demonstrated ability to perform the Essential Duties of the position with or without accommodation • Authorization to work in the United States without sponsorship. Benefits: • paid time off (including days for vacation, holidays, volunteering, and personal time) • paid leave for parents and caregivers • retirement savings plan • wellness support • health benefits including medical, prescription drug, dental, and vision coverage