Our mission at Progenity is simple: to help healthcare providers and patients prepare for life. We provide the most advanced molecular technology and the highest levels of service to guide patient care at critical life stages. We continually seek people with the motivation and skills to advance our mission.
The Case Manager is responsible for supervising, developing, and facilitating all activities including securing coverage by completing all assigned prior authorization activities and working relationships with contracted and non-contracted healthcare payors for complex molecular and specialized testing services and hereditary genetic testing services.
- Receives requests from the Financial Services department for prior authorization. Reviews requests for completeness and communicates any missing information to Financial Services for follow-up with healthcare providers (clients) and patients.
- Completes all required authorization documentation and submits request to payor in a timely and accurate manner.
- Completes and documents all required follow-up contacts with payors and Financial Services for each authorization request until resolved.
- Adheres to all applicable company and departmental Standard Operating Procedure (SOP) documents.
- Supports established partnerships and relationships with payors as well as all healthcare utilization management companies.
- Participates in organizational initiatives related to process development, program management, and/or operational efficiencies.
- Maintains compliance with applicable State and Federal regulations, including CLIA and HIPAA regulations.
This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities, as deemed necessary.
- Bachelor’s Degree in Business or Healthcare, or related field.
- Familiarity and experience working with payors including Commercial, Marketplace, Medicare, Medicaid, TriCare, and Medical Groups is preferred.
- Past experience with medical benefits/claims, authorizations, and provider appeals is a plus.
- Knowledge of ICD-10 and CPT codes.
- Must be professional, highly dependable, and work extremely well under pressure.
- Excellent interpersonal skills and the ability to collaborate effectively with other team members.
- Must have the ability to organize and prioritize work to meet required deadlines.
- Possess strong verbal and written communication and problem-solving skills.
- Intermediate knowledge and experience with Microsoft Windows, Microsoft Office products, Internet, and general office equipment.
Progenity, Inc., is a privately held company providing complex molecular and specialized diagnostic tests to clinicians with a focus on clear, actionable results that enable informed medical decisions.
At Progenity, we are committed to providing our clients with accurate, timely results, and the highest level of service in the industry. And we’re equally committed to cultivating our employees by giving them opportunities to grow and perform to their fullest potential. We continually seek individuals with the motivation and skills to succeed.