Benefits Investigation and Eligibility Specialist

🕒 September 15

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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Baylor Genetics

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1978

🏥 Healthcare

💼 Consulting

🍽️ Food & Beverage

Healthcare • Consulting • Food & Beverage

Baylor Genetics is a clinical genomics and precision diagnostics laboratory affiliated with Baylor College of Medicine that provides comprehensive genetic testing and interpretation services. The company offers whole genome and whole exome sequencing, chromosomal microarray analysis, mitochondrial testing, pharmacogenomics, and specialized assays, along with genetic counseling, provider support, and insurance/payment resources. Baylor Genetics supports healthcare providers, researchers, and families with AI-enhanced interpretation, multimodal data integration, and end-to-end clinical and laboratory services.

📋 Description

• Verify active primary, secondary, and tertiary insurance coverage, including member details, demographics, effective dates, plan type, payer information, and coordination-of-benefits requirements • Use payer portals, electronic eligibility tools, and direct payer contact to validate coverage and resolve insurance discrepancies • Contact patients and provider offices to obtain missing or corrected insurance information and escalate unresolved issues • Investigate benefits for genetic and molecular diagnostic services, including deductibles, copayments, coinsurance, out-of-pocket amounts, benefit limitations, and network requirements • Identify prior authorization, notification, referral, medical records, and other payer requirements • Route cases to the appropriate team with complete supporting information • Document benefit findings, payer representatives, reference numbers, call dates, portal results, and follow-up actions accurately • Communicate eligibility and benefit findings clearly without making coverage guarantees • Manage assigned work queues independently, prioritize time-sensitive cases, follow up within established turnaround times, and meet productivity and quality expectations • Research and resolve routine issues, review work for accuracy and completeness, maintain auditable documentation, and escalate payer, system, or policy issues • Participate in training, quality reviews, and workflow improvements • Protect patient, client, financial, and company information in accordance with HIPAA and Baylor Genetics policies • Perform other job-related duties as assigned

🎯 Requirements

• High school diploma or equivalent • 2+ years of experience in healthcare insurance verification, benefits investigation, patient access, revenue cycle, or a related function • Working knowledge of commercial insurance, Medicare, Medicaid, and managed care plans • Experience using payer portals, electronic eligibility tools, and healthcare or revenue cycle systems • Ability to work independently, research issues, make sound decisions within established procedures, and escalate appropriately • Strong problem-solving skills and ability to resolve incomplete, conflicting, or unclear insurance information • Exceptional attention to detail and accuracy in data entry, documentation, and follow-up • Strong written and verbal communication skills with a professional, patient-centered approach • Ability to manage multiple cases and priorities in a production-based environment • Ability to handle protected health information and confidential financial information appropriately • Preferred: Associate degree in healthcare administration, business, or a related field • Preferred: Experience in diagnostic laboratory, genetics, molecular diagnostics, pathology, or specialty healthcare • Preferred: Experience with Quadax, Salesforce, clearinghouses, payer portals, or similar systems • Preferred: Familiarity with prior authorization workflows, payer medical policies, and patient financial responsibility • Compliance with HIPAA, Baylor Genetics policies, and applicable payer and regulatory requirements

🏖️ Benefits

• Remote work arrangement • Reasonable accommodations in accordance with applicable law • Equal opportunity and inclusive workplace • Training, quality reviews, and workflow improvement participation

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