Billing Support Specialist

Billing Support Specialist

Scipher Medicine is seeking a qualified and dedicated Billing Support Specialist to join our Billing team. This full-time position reporting directly to the Billing Manager is based out of our Waltham Ma, office.

As a key member of the team, you will be responsible for a variety of tasks including providing customer service and support to our patients for all billing inquiries.

To succeed in this role, you must possess strong communication skills, both orally and written, a thorough understanding of billing systems, claims processing, insurance plans and appeal processes.

Essential responsibilities include the following but are not limited to and other duties may be assigned :

• Heavy emphasis on speaking with potential patients or providers regarding patient expected out of pocket costs including both inbound and outbound calls
• Address patient billing questions and resolve accordingly

Front-End billing functions such as :

Data entry of patient insurance plan and demographics into Salesforce

Reviewing worklists assigned by our billing vendor and resolve any questions to ensure timely filing of our claims

Manage the prior-authorization process for our claims when applicable

Potential calls to providers for additional documentation to ensure successful claim submission / adjudication

Identify and communicate necessary changes to improve departmental efficiencies

Required skills :

A keen disposition when speaking with patients regarding their out-of-pocket costs.

Quadax billing system and Salesforce experience highly preferred

Experience with insurance verification and prior-authorization process

Thorough understanding of commercial and government payer behavior

Must be able to comprehend and communicate EOB details

Knowledge of appeal processes

Online portal data entry experience

Excellent communication skills

Microsoft Office 365 proficiency

Comfortable on Zoom / Microsoft Teams for daily meetings

Organization, time management and prioritization abilities

Must be able to work in a fast-paced environment and provide solutions to processes not yet defined

Maintains confidentiality; adheres to all HIPAA guidelines and regulations

Basic qualifications :

3-5 years of insurance billing experience preferably within a laboratory environment

Customer service, data entry, insurance verification, understanding the life of a claim, appeals and prior-authorization experience

Associate’s degree and / or Medical Billing Certification preferred. May be substituted DOE

About Scipher Medicine

Scipher Medicine develops innovative diagnostic tests to determine drug response and targeted therapies using our proprietary personalized medicine platform based on molecular technology.

We hold a fundamental belief that patients deserve simple answers to their treatment plans using scientifically backed data.

Our platform allows us to interpret genomic data to gain unique insights into disease biology so patients with even the most complex diseases can achieve optimal health outcomes.

With only about 1 out of 3 rheumatoid arthritis (RA) patients adequately responding to anti-tumor necrosis (anti-TNF) therapies, the world’s largest selling drug class, we developed our flagship test, PrismRA™, to predict response to these drugs, thereby ensuring patients receive more effective therapies from day one.

Scipher is transforming the traditional diagnostics business model by working closely with payers and physicians to change the way medications will be prescribed, substantially improving patient outcomes while saving both insurers and patients billions wasted in ineffective prescription costs.

This is a unique opportunity to join a promising venture at an early stage to tackle some of the biggest problems in healthcare.

Scipher is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law