Benefits Investigation Manager

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

The Benefits Investigation Manager will oversee our benefits investigation and prior authorization departments. In this role, you will be responsible for ensuring patients are provided with cost estimates, financial options for testing, and ensuring all applicable testing is submitted for prior authorization. This role is accountable for authorization approvals and will partner closely with our internal Genetic Counselors, Client Services and Sales Team to ensure our clients provide records for medical necessity.

Key Job Elements

• Plan, direct, and manage supervisors and staff to ensure timely, accurate, and complete processing of services while ensuring all quality and production goals are met
• Tracks KPIs related to team's performance, authorization approval rates, and denial reasons. Presents metrics to senior leadership with resolutions on how to improve overall company performance.
• Works with 3^rd party vendors related to benefits investigation to ensure SLAs and expectations are met.
• Manage day-to-day operations and personnel in planning and facilitating efficient insurance verification services to ensure quality and customer satisfaction. (i.e., program development, process improvement, etc.)
• Use experience and knowledge in end-to-end revenue cycle operations to serve as a liaison between the client and the service delivery teams.
• Demonstrate the ability to understand and articulate client needs and priorities that align with benefits investigation services.
• Be a SME on all billing related process aspects (including prior authorizations and benefits investigations) to the service delivery teams.
• Train the service delivery teams on answering benefits investigation related questions and work with marketing to provide educational information for clients and patients.
• Develop robust SOPs, processes, and training materials.
• Resolve employee relations issues and recommend disciplinary action when required.
• Build strategic client relationships that will lead to long-term partnerships
• Other related projects and duties as assigned.

Knowledge/Experience

• 10+ years of experience in billing, benefits investigation and/or prior authorizations.
• Must have experience in prior authorizations. Preferably NGS testing.
• 7+ years of experience leading or supervising billing, benefits investigation and/or prior authorizations teams.
• Bachelor's degree in business administration, healthcare or related field; or equivalent experience
• Interpersonal Skills - The ability to establish oneself as a trusted partner for counterparts; to effectively communicate and engage with all stakeholders of the organization, including physician and health system partners.
• Knowledge of Revenue Cycle Management functions, including, but limited to Data Entry, ICD9
• Coding, Accounts Receivable Management, and Remittance Application.
• Proficient in Microsoft Office Suite, specifically Word, Excel, and Outlook, and general working
• knowledge of Internet for business use.
• Ability to work in a fast-paced, deadline driven environment.
• The role requires staying up to date with payer and policy changes/updates, and working collaboratively with the clients, the service delivery teams, and RCM

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.