Clinic & Billing Specialist

Member Services New York, New York


Description

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 us…

Progyny is a leading fertility benefits management company in the US. We are redefining fertility and family building benefits, proving that a comprehensive and inclusive fertility solution can simultaneously benefit employers, patients, and physicians. Our benefits solution empowers patients with education and guidance from a dedicated Patient Care Advocate (PCA), provides access to a premier network of fertility specialists using the latest science and technologies, reduces healthcare costs for the nation’s leading employers, and drives optimal clinical outcomes. We envision a world where anyone who wants to have a child can do so. 

Our mission is to make any member’s dream of parenthood come true through a healthy, timely, and supported fertility and family building journey. 

Come join a company that’s been recognized by Modern Healthcare as one of the Best Places to Work in Healthcare. 

Our perks: 

  • Family friendly benefits: 
    • Paid maternity and paternity 
    • Fertility benefits (including egg freezing and IVF) 
    • Emergency childcare program 
    • Parent’s group 
  • Health, dental, vision and life insurance options for employees and family 
  • Paid vacation and summer flex time 
  • Company equity 
  • Bonus program 
  • 401K Match 
  • Monday breakfasts/ Friday lunches/ healthy snacks 
  • Company social events 
  • Sit/ stand desks  

Progyny is an Equal Opportunity Employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills and experiences within our workforce.