About the Role
Clinic & Billing Specialist
Remote
New York, New York
Full time
Thank you for considering Progyny!
We are looking for a dynamic Clinic and Billing Specialist to handle daily interactions with our members and in-network clinics in creating and sending authorizations, answer billing inquiries, resolving member billing issues, reviewing denied claims, answering a high volume of phone calls and emails. The successful candidate will be able to ensure an elevated level of customer service, maintaining positive relationships within the network and maximizing productivity by reviewing accuracy for claims processing. The Clinic and Billing Specialist must be able to operate in a fast-paced environment, manage difficult conversations, be thoughtful, resourceful, collaborative, and customer focused.
This is a call center position.
Whatyou’lldo…
- Manage a high volume of provider and member calls and emails
- Cultivate provider network relationships through superior provider service andprovide best-in-class member experience with acompassionate attitude towardsresolving member billing issues
- Be obsessed with providing the best possible provider and member experience at all times
- Review, research and analyze complex fertility related claims by navigating multiple systems and platforms and accurately capture the data/information for processing (e.g. verify pricing, prior authorizations, applicable benefits)on a weekly basis
- Communicate with providers regarding claim payment or required additional information for claims payment
- Explain financial responsibility as it relates to member deductible, coinsurance, and out-of-pocket max; be able to interpret invoices and explain medical billingin away memberswill appreciate and understand
- Interpret and enforce clinic contracts as it relates to covered services and authorizations; be a persuasive speaker in encouraging partner providers to maintain compliance with best practices and guidelines
- Be flexibleand to adapt with evolving business needs
- Available to work Monday-Friday 12pm-9pm EST
About you…
- Someexperience required in a health care environment—knowledge of the fertility industry is strongly preferred.
- Available to work Monday-Friday 12pm-9pm EST
- Demonstrated ability in Microsoft excel required, and Salesforce knowledge preferred
- Ability to manage multiple priorities including understanding various insurance products and levels of benefit within each product.
- Comfortable in an environment with data-driven goals with monthly performance feedback
- Call center experience preferred
- Flexible and unafraid of change
- Ability to manage difficult conversations and overcome objections required
- Knowledge of CPT, HCPCS, AND ICD-10 codes and understanding of medical terminology strongly preferred
- Ability to work independently and demonstrate good judgment
- Excellent interpersonal skills – ability to communicate accurately and effectively with internal and external stakeholders
- Highly organized, quick learner, with ability to multitask and prioritize work effectively