About Us

We are tackling one of the largest problems in healthcare. In autoimmune conditions, a common clinical practice includes trial-and-error approaches to determine the right therapy for a patient. At Scipher Medicine, we are developing an innovative portfolio of personalized medicine solutions in complex diseases. Scipher's platform identifies and guides physicians towards a more targeted approach to determine the best treatment for their patients, based on their patient’s own fundamental disease biology. We have a growing pipeline of products being developed and the potential to predict which therapies patients will respond to, ensuring optimal treatment is prescribed from day one.

This includes PrismRA, a precision medicine test that helps guide healthcare providers’ treatment decisions in patients with rheumatoid arthritis. Pipeline indications span the autoimmune and immune-mediated disease space.

Job Overview

The Medical Billing Specialist performs a variety of functions including but not limited to navigating billing software, accurate follow up of claims, communicating with insurance carriers, requesting retro authorizations, submitting timely appeals, reading EOB’s, performing individual benefit investigations, communicating insurance plan behaviors on claim processing to management, and other related functions.

Key Responsibilities:

• Knowledge of Medicare/Medicaid Governmental Benefits & Regulations
• Knowledge of Medical Insurance Coverage’s, Third Party Billing regulations
• Manage the appeal process as applicable by insurance plan, including retro authorization requests as needed by plan
• Inbound and outbound calls to patients and/or providers regarding patient expected out of pocket costs, out of network denials and patient billing statements
• Follow up on insurance aging A/R including resolving claim denials
• Accurately and efficiently enter data to bill clean claims to the insurance in a timely manner
• Ability to work a minimum of 30-40 accounts per day
• Performs other job-related duties, as required, and assigned

Qualifications:

• Out-of-Network Commercial Insurances knowledge including proficiency with payer portals (Availity, NaviNet, Office Alley, UHC and Medicare) Previous medical billing experience along with knowledge of insurance plan behavior
• Strong communication skills, attention to detail and follow up, ability to prioritize and multi-task with strong organizational, and computer skill sets.
• Proficiency with Microsoft Office products including Word, Teams, Excel, and Power Point
• Comfortable in a fast-paced environment and provide solutions to processes not yet defined
• Maintains confidentiality; adheres to all HIPAA guidelines and regulations
• Medical Billing: 2+ years of prior experience, preferably within a laboratory environment
• Medical Billing Certification (preferred)
• Quadax billing system and Salesforce experience highly preferred

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