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Case Manager

Company: Progenity
Location: Irving
Posted on: October 12, 2019

Job Description:

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 insurance coverage, obtaining and maintaining relationships with healthcare payors, providers and patients for hereditary genetic testing services.RESPONSIBILITIES


  • Processes requests for prior authorization, including: review requests for completeness, communicate missing information or other follow-up activities to ordering providers and/or patients and facilitates the prior authorization with a diverse group of payors.
  • Documents all activities with payors, providers, patients and internal departments for all sample requests.
  • Adheres to all applicable company and departmental Standard Operating Procedures.
  • 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 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.REQUIREMENTS


    • RN or LPN required.
    • Licensure and certification as required by individual's degree.
    • Experience working with insurance required including experience with medical benefits/claims, authorizations and provider appeals and knowledge of ICD-10 and CPT codes.
    • Familiarity and experience working with payors, minimum of 2 years required.
    • Excellent communication, interpersonal and analytical skills.
    • Ability to triage issues appropriately and understand when to escalate concerns.
    • Excellent judgement and discretion.
    • Ability to handle multiple priorities simultaneously, meet deadlines, handle work-related stress is required in a fast-paced, challenging work environment.
    • Must be detailed oriented, organized, self-starter, can prioritize workload and have a positive attitude.
    • Occasional travel will be required.
    • Must be tech-savvy, including intermediate knowledge and experience with Microsoft Windows, Microsoft Office products, Internet and general office equipment.

Keywords: Progenity, Irving , Case Manager, Executive , Irving, Texas

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