Eurofins Scientific is an international life sciences company, providing a unique range of analytical testing services to clients across multiple industries, to make life and our environment safer, healthier and more sustainable. From the food you eat, to the water you drink, to the medicines you rely on, Eurofins works with the biggest companies in the world to ensure the products they supply are safe, their ingredients are authentic and labelling is accurate.

Eurofins is the global leader in food, environment, pharmaceutical and cosmetic product testing and in agroscience Contract Research Organisation services. Eurofins is one of the market leaders in certain testing and laboratory services for genomics, discovery pharmacology, forensics, advanced material sciences and in the support of clinical studies, as well as having an emerging global presence in Contract Development and Manufacturing Organisations. The Group also has a rapidly developing presence in highly specialised and molecular clinical diagnostic testing and in-vitro diagnostic products.

In over just 30 years, Eurofins has grown from one laboratory in Nantes, France to 55,000 staff across a decentralised and entrepreneurial network of 900 laboratories in over 50 countries. Eurofins offers a portfolio of over 200,000 analytical methods to evaluate the safety, identity, composition, authenticity, origin, traceability and purity of biological substances and products.

Job Description

Transplant Genomics Inc. (“TGI”) is a molecular diagnostics company committed to improving organ transplant outcomes with non-invasive serial monitoring guided by biomarkers. TGI’s product portfolio of individual and combined whole blood gene expression and donor derived cell-free DNA testing can reliably rule out subclinical kidney rejection and acute rejection in kidney transplant patients. In addition to kidney transplantation testing, our newest product for liver transplant patients is a blood-based biomarker assay designed to rule out rejection as immunosuppression therapy is optimized.

The Pre-Authorization and Billing Specialist effectively communicates the estimated financial responsibility of the member and obtaining prior authorization for billing. To achieve this, the Specialist is responsible for verifying the receipt of test order IDs, checking the member's insurance and benefits, communicating the member's financial responsibilities to the patient and/or sales team, submitting prior authorization requests through payor websites, fax or phone, and procuring medical records or documentation as required by insurance prior authorization or appeals. They must also keep up to date with changes in insurance policies and pre-certification requirements and maintain current knowledge of payor websites and utilization. Reviewing claims in Xifin and resubmitting them to payors for Pre-authorization reviews is also part of their job. They are responsible for ensuring that pre-certification, authorization, and referrals are in place for all cases. Entering payor and responsible party information accurately into the accounting system is crucial. The Specialist must also possess exceptional task prioritization skills and the ability to review tasks efficiently and thoroughly. In case of necessity, the Specialist should cross-train in various duties within the Billing department. Research is also a crucial aspect of this role, and the Specialist must follow up and know how to appeal prior authorization rejections/denials. This role also includes monitoring FAP's.

Essential Job Duties:

Verify patients’ insurance and benefits.
Communicate patients’ responsibilities.
Notify management of identified trends as needed, and at month-end, arrange payment plans.
Enroll patients in Financial Assistance Programs.
Submit prior authorization requests to payor websites, fax, or phone.
Obtain medical records or documents requested by the insurance for Prior Authorization.
If the patient accepts, run their insurance.
If the patient declines, complete a cancellation form or offer payment options.
Offer prompt pay discounts, arrange payment plans, and provide financial assistance as needed.
Meet daily and monthly departmental productivity goals set by management to achieve the company's financial goals.
Ensure completion and recording of documentation.
Be responsible for protecting, securing, and properly handling all PHI (Protected Health Information).
Perform other duties as assigned.
Research, review, and communicate with insurance carriers regarding open accounts receivable.
Prepare and submit appeals.
Timely management of unpaid claims.
Correct claim errors and coordinate, monitor, and manage the follow-up on unpaid claims in a timely manner.
Responsible for the timely accurate submission of all prior authorizations for service to the responsible payer
Ensure that all payers needing prior authorization are set up correctly within the software system.
Review accuracy and completeness of information requested and ensure that all supporting documents are present.
Performs pre-service authorization reviews to obtain payment authorization for outpatient services.
Succinctly abstracts fact based clinical information to support pre-authorization utilizing applicable nationally recognized and payer-specific criteria; communicates timely the clinical information supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task.

Level I RCPA&BS – Minimum Requirements:

Compile, process, and maintain patient files to handle storage and retention of clinicals.
Other duties as assigned by management

Level II RCPA&BS – Minimum Requirements:

Demonstrate effective teamwork skills by knowledge-sharing
Participate on special project teams as requested by supervisory staff

Level III RCPA&BS – Minimum Requirements:

Obtain advanced knowledge of standard operating procedures
Participate in troubleshooting activities in conjunction with the Supervisor/Manager
Recommends and assist with implementing process improvements.

Level Lead – Minimum Requirements:

Effectively supervise the billing/Pre-Authorization, providing expert guidance and unwavering support as needed.
Proactively conduct regular audits of billing processes to identify areas for improvement and implement innovative solutions.
Proactively Assist with complex special projects, escalate high-level billing issues to management, and perform other duties as assigned.
Creating/scheduling/analyzing billing reports for the department to identify patterns/issues that could have a financial impact (including monitoring write-offs submitted by the department)
Take on formally assigned additional duties, such as training, as a part of routine job performance
Strong empathy and patience

Qualifications

Essential Experience, Knowledge, Skills and Abilities:

Excellent customer service skills, with a focus on professionalism
Ability to solve problems, prioritize tasks, and multitask effectively
Goal-oriented mindset with excellent time management and organizational skills
Strong interpersonal communication skills, including the ability to interact efficiently with individuals at all levels in an organization
Excellent verbal and written communication skills
Attention to detail, accuracy, and time management
Proficiency in PC-based software such as Microsoft Excel, Teams, iPhone, Adobe, and associated applications
A fundamental understanding of medical billing concepts
Knowledge of Medicare, Medicaid, and commercial insurance
Familiarity with HIPAA (Health Insurance Portability and Accountability) privacy requirements
Knowledge of Availity and eligibility portals and medical terminology
Follow up on missing or incorrect information so patients receive the right reimbursement.
Document account activity using correct medical and billing codes.
Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
Be investigative to find necessary information, if needed
Ability to handle multiple priorities and meet deadlines
Ability to work independently and as part of a team in a fast-paced environment
Demonstration of self-motivation and ownership of assigned work
A high level of professionalism and confidentiality in handling sensitive information is imperative.
Ability to self-start and work independently as well as respond to STAT requests in a timely manner
Excellent verbal & written communication skills.
Analytical judgment, problem-solving skills, accuracy, and strong orientation.
Bilingual experience a plus.

RCPA&BS I – Minimum:

A high school diploma, GED, or equivalent education
A minimum of 1 year of experience in billing with knowledge of EOBs, deductibles, and co-pays
1 year of client and operational experience in diagnostics, specifically within a medical facility or lab environment, preferred.
Strong level of empathy and patience

RCPA&BS II – Fully meets the

qualifications

of Level I plus the following:

A minimum of 2 years' experience in billing with knowledge of EOBs (Explanation of Benefits), deductibles, and co-pays is required.
A minimum of 2 years' client and operational experience in diagnostics is preferred.
The candidate should possess excellent customer service skills, professionalism, and the ability to solve problems, prioritize, and multitask.
The candidate should be goal-oriented, with excellent time management and organizational skills.

RCPA&BS III – Fully meets the

qualifications

of Level II plus the following:

A minimum of 4 years' experience in billing with knowledge of EOBs (Explanation of Benefits), deductibles, and co-pays is required.
A minimum of 4 years' client and operational experience in diagnostics is preferred.

RCPA&BS Lead – Fully meets the

qualifications

of Level III plus the following:

A minimum of 7 years' strong knowledge experience in billing with EOBs (Explanation of Benefits), deductibles, and co-pays is required.
A minimum of 7 years' client and operational experience in diagnostics is preferred.
The candidate should possess excellent customer service skills, professionalism, and the ability to solve problems, prioritize, and multitask.
The candidate should be goal-oriented, with excellent time management and organizational skills.

Physical Requirements:

Physical dexterity sufficient to use hands, arms, and shoulders repetitively to operate a keyboard and other office equipment, use a telephone, access file cabinets and other items stored at various levels, including overhead.
Ability to speak and hear well enough to communicate clearly and understandably with sufficient volume to ensure an accurate exchange of information in normal conversational distance, over the telephone, and in a group setting.
Ability to continuously operate a personal computer for extended periods of time (4 or more hours)
Mental acuity sufficient to collect and interpret data, evaluate, reason, define problems, establish facts, draw valid conclusions, make valid judgments and decisions.
Ability to travel (as needed)

The essential physical and mental requirements described here are representative of those that must be met by an employee to successfully perform the job's essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Additional Information

What we offer:

Excellent full time benefits including comprehensive medical coverage, dental, and vision options
Life and disability insurance
401(k) with company match
Paid vacation and holidays
Monday-Friday 8:00am-5:00pm
Salary Range: $20-$29/hour

Eurofins is a M/F, Disabled, and Veteran Equal Employment Opportunity and Affirmative Action employer.