Clinic & Billing Specialist

Thank you for considering Progyny! We are looking for a dynamic Provider Relations 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 Provider Relations & Billing Specialist must be able to operate in a fast-paced environment, manage difficult conversations, be thoughtful, resourceful, collaborative, and customer focused. What you'll do... Manage a high volume of provider and member calls and emails Cultivate provider network relationships through superior provider service and provide best in-class member experience with a compassionate attitude towards resolving 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 billing in a way members will 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 flexible and to adapt with evolving business needs About you... Some experience required in a health care environment-knowledge of the fertility industry is strongly preferred. Undergraduate degree strongly preferred 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 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 About Progyny: Progynyis a transformative fertility, family building and women's health benefits solution, trusted by the nation's leading employers, health plans and benefits purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians. Our benefits solution empowers patients with concierge support, coaching, education, and digital tools;provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs. Our mission is toempower healthier, supported journeys through transformative fertility, family building and women's health benefits. Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit Our perks: Family friendly benefits: Paid family and parental leave, fertility and family building benefits (including egg freezing, IVF, and adoption support), family care fund and Parents' Employee Resource Group Health, dental, vision and life insurance options for employees and family Free in-person, virtual and text-based mental health and wellness support Paid time off, including vacation, sick leave, personal days and summer flex time Company equity Bonus program 401(k) plan with company match Access to on-demand legal and financial advice Company social events Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office In compliance with New York City's Wage Transparency Law, the annual salary [wage] range for NYC-based applicants is: $24.00/hour - $28.00/hour. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity. Progyny is proud to be anEqual Opportunity and Affirmative Action employer.We respect and seek to empower each individual and support the diverse cultures, perspectives,skillsand experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law. If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e-mail to . #LI-BR1 Minimum Salary: 31200.00 Maximum Salary: 31200.00 Salary Unit: Yearly

Created: 2024-11-21