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Ambry Genetics · 23 hours ago

PFS Auditor, Remote

United States

Full-time

Remote

New Grad, Entry Level

$30/hr - $35/hr

Ambry Genetics is a company focused on patient financial services, and they are seeking a PFS Auditor to review and appeal claims related to clinical validation and coding denials. The role involves conducting audits, ensuring compliance with billing practices, and collaborating with other departments to improve processes.

Health CareHealth DiagnosticsMedical

Responsibilities

Conducts SOX reviews by assessing internal controls and auditing billing processes

Conducts pre and post billing reviews to ensure quality standards are met prior to billing. Completes assignments in a manner that meets the quality assurance goal of 100% accuracy

Monitors the results of claims audit policies and procedures and reports findings to appropriate leadership

Utilizes Medicare and Contractor guidelines for coverage determinations. Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits

Participate in pre- & post-review meetings, providing support and recommendations for issues presented. Ensure past review recommendations are implemented in current review process

Provides a broad-based knowledge in billing and collections, strong knowledge of industry practice and business principles to ensure department is compliant with all billing practices

Works in partnership with other departments for education on patient billing policies and process improvements

Other duties as assigned

Qualification

CPCCPMAICD-10-CMCPT codesMedical terminologyInsurance plansAdaptability

Required

Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes

Utilizes Medicare and Contractor guidelines for coverage determinations. Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits

Must have ability to adapt to a fast paced, dynamic environment