PFS Auditor

Compensation: 

$26.00 - $33.00 per hour. You are eligible to a Short-Term Incentive Plan with the target at 5% of your annual earnings, terms and conditions apply.

Job Overview:

The PFS Auditor works with PFS management, attorneys and claims representatives by reviewing and appealing claims when appropriate to overturn clinical validation and coding denials from Medicare, Medicaid, and other third-party payers.

Duties and Responsibilities:

1. 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.
2. Monitors the results of claims audit policies and procedures and reports findings to appropriate leadership.
3. Utilizes Medicare and Contractor guidelines for coverage determinations. Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits.
4. Participate in pre- & post-review meetings, providing support and recommendations for issues presented. Ensure past review recommendations are implemented in current review process.

1. 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
2. Works in partnership with other departments for education on patient billing policies and process improvements
3. Other projects as assigned

Education and Knowledge:

• CPC or CPMA preferred
• Associates degree preferred
• 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

Technical Competencies:

• Must have excellent computer skills
• Must understand the different payer plans and good understanding of A/R
• Must have thorough understanding of billing and collection requirements m
• Must be analytical, detailed and organized
• Must be able to meet deadlines in a timely manner

Experience:

• 3+ years relevant experience to include minimum 2+ years billing and coding experience. Equivalent combination of education and experience will be considered.

#LI-SS1 #LI-REMOTE

About Us: 

Ambry Genetics Corporation is a CAP-accredited and CLIA-licensed molecular genetics laboratory based in Aliso Viejo, California. We are a genetics-based healthcare company that is dedicated to open scientific exchange so we can work together to understand and treat all human disease faster.

At Ambry, everyone is welcome. A career at Ambry Genetics is a chance to be part of a dynamic company that aims to improve health by understanding the relationships between genetics and human disease. We earned our reputation as industry leaders by responsibly introducing cutting-edge genetic testing solutions and continually sharing what we learn with the global scientific community.

At Ambry you will be learning, challenging yourself, and having fun while collaborating with teammates through the open exchange of ideas.  Our outstanding benefits program includes medical, dental, vision, FSA, paid sick leave and generous paid time off (PTO) program. You can learn more about the benefits here. Ambry Genetics is an Equal Opportunity Employer (EOE) and we maintain a drug-free work environment.

The Company believes in second chance employment.  Qualified applicants with arrest or conviction history will be considered regardless of their arrest or conviction history, consistent with local laws such as Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.  You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if the Company is concerned about conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. For the purpose of the above job description, “Essential Functions” are “Material Job Duties”.

Our salary ranges are determined by role, level, and location. The range displayed on each job posting reflects the minimum and maximum target for new hire salaries for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training.

All qualified applicants will receive consideration for employment without regard to race (and traits historically associated with race, including, but not limited to hair texture and protective hairstyles such as braids, locks, and twists), color, creed, religion, sex, sexual orientation, gender identity, gender expression (including transgender status), national origin, ancestry, age, marital status or protected veteran status and will not be discriminated against on the basis of disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances. If you have a disability or special need that requires accommodation, please contact us at careers@ambrygen.com

Ambry does not accept unsolicited resumes from individual recruiters, third party recruiting agencies, outside recruiters or firms without an executed contract in place. We are not responsible for any fees related to resumes that are unsolicited or are received by Ambry. Such resumes will be deemed the sole property of Ambry and will be processed accordingly.

PRIVACY NOTICES

To review Ambry’s Privacy Notice, Click here:    https://www.ambrygen.com/legal/privacy-policy

To review the California privacy notice, click here: California Privacy Notice | Ambry Genetics

To review the UKG privacy notice, click here: California Privacy Notice | UKG