OPT Benefits Specialist Jobs

About us

Inform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology.

Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform.

Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike.

Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel nanoencapsulation and targeted therapy platform. By merging our fields of expertise, we aim to become a fully integrated precision medicine company.

Summary of Position

Inform Diagnostics, a Fulgent Genetics Company, is looking for an experienced supervisor for the benefit investigation (BI) unit who works well in prioritizing and managing the timely completion of BI requests from patients and clients. The BI supervisor is responsible for a broad range operational support to client services, sales team, IT and the revenue cycle team. The role’s duties include maintenance of an updated fee schedule and standard operating procedures in providing patients different payment options. In this role, the supervisor owns the responsibility of managing daily workflow, prioritizing and organizing tasks, monitoring the performance of staff, and acts as the subject matter expert in all areas of BI.

Key Job Elements

• Supervises the work distribution and workflow of the BI Team.
• Supervises and monitors daily work performance. Including call monitoring, production tracking, attendance, turnaround times, and quality tracking.
• Conducts monthly 1:1s with staff and coaches to improve team’s overall performance.
• Ability to motivate and engage team while holding them accountable to high standards.
• Creates schedules, approves timecards, and PTO requests.
• In production as needed.
• Conducts new hire and refresher trainings as needed.
• Establish priorities and must be able to multi-task so that assigned duties are completed under the pressures of time constraints and deadlines.
• Reports employee and department level metrics to senior leadership.
• Use of good communication; oral, hearing, and written.
• Ensures patient demographic, insurance and referring physician information are accurately entered into system.
• Checking that automation of eligibility verification are optimized.
• Confirming provider credentials with insurance companies and hospitals.
• Reviewing patient bills for accuracy and completeness and obtaining any missing information.
• Ensures all prepayments are applied on time on self-pay accounts.
• Calling insurance companies regarding any discrepancy in patient eligibilities.
• Negotiating single case agreements with third party payors.
• Acquiring knowledge of medical terminology likely to be encountered in medical claims.
• Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPPA).
• Performing other related duties or special projects as assigned.

Knowledge/Experience

• Bachelors or Associate Degree is preferred but not required.
• Minimum of 4 years work experience in patient benefits, pre-authorizations and/or billing experience.
• Minimum of 5 years of previous supervisory experience.
• Understanding of Laboratory reimbursement methodologies and standard payment methodologies.
• Knowledge of CPT and ICD-10 and coding.
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Knowledge of and experience with contract payer policies and procedures.
• Knowledge of HIPPA compliance.
• Proficient in Microsoft Office Suite applications.

Additional Skills

• Handles multiple tasks simultaneously.
• Communicates effectively with all levels of staff.
• Maintains composure while working under high pressure.
• Demonstrates strong interpersonal skills that foster a positive environment.
• Demonstrates flexibility and ability to adapt to change.
• Excellent communication, time management, and computer skills.
• Must be accurate with attention to detail.
• Customer service skills for interacting with medical billing clients and office patients regarding medical claims and payments.
• Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion.
• Problem-solving skills to research and resolve discrepancies in billing data. A calm manner and patience working with either patients, insurers, or co-workers during this process.

Supervisory Responsibilities:

• Yes

Reports To:

• Manager, Benefits Investigation

Environment

Fulgent Therapeutics LLC is an Equal Employment Opportunity Employer.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term “qualified individual with a disability” means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position.

Please note that Fulgent (and its affiliated companies, including Inform Diagnostics and CSI Laboratories) does not accept unsolicited information and/or resumes from search firms or agencies for our job postings. Search firms or agencies without an applicable contract and/or express approval to recruit for the role in question — that choose to submit a resume or client information to our career page or to any employee of Fulgent — will not be eligible for payment of any fee(s), and any associated shared data will become the property of Fulgent.