Exagen is a patient-focused and discovery-driven life sciences company dedicated to transforming the care continuum for patients suffering from debilitating and chronic autoimmune diseases. Our goal is to enable rheumatologists to improve care for patients through the differential diagnosis, prognosis, and monitoring of complex autoimmune and autoimmune-related diseases, including lupus and rheumatoid arthritis. By leveraging our proprietary Cell-Bound Complement Activation Products, or CB-CAPs, technology, we help get to the real cause of a patient’s symptoms and guide their journey to improved health.

Under the direction of the Billing Supervisor and/or Prebilling Team Lead, the Pre-Biller is responsible for managing claims from submission to adjudication.  The Prebiller will be responsible for ensuring accurate and efficient medical billing operations. They will also verify insurance coverage and benefits, initiate prior-authorizations and review medical records to ensure accurate billing practices. Qualified candidates will have extensive knowledge of medical and third-party billing procedures, policies and concepts, a thorough understanding of Federal and State health programs, PPO, HMO, and Indemnity Plans.

Location note: This is a hybrid position that requires on-site work out of our Carlsbad office and candidates must live within commuting distance.

• Prepares and submits clean claims to various insurance companies in a timely manner.
• Responsible for all pre-bill edits and claim/payer rejections to ensure accuracy and compliance with all government and commercial carriers billing guidelines before releasing for submission to payers.
• Responsible to bill all services within a timely filing as defined by departmental goals and insurance guidelines.
• Verify insurance eligibility, benefits, and coverage.
• Obtain prior authorizations for procedures as required by insurance carriers.
• Accurately enter patient demographics, insurance information, and authorization details into the billing system.
• Collaborate with internal teams to obtain necessary documentation and information for billing purposes.
• Follows up on any deficiencies that haven’t been resolved, including making outbound phone calls.
• Maintain accurate and organized billing records and documentation
• Other duties as assigned

• Minimum of 2 years’ experience, preferably in a laboratory billing environment
• Strong understanding of insurance billing, including Medicare, Medicaid and commercial insurance plans
• Able to identify payer and claim rejection trends and provide solutions for process improvements and enhancements to improve clean claim rates
• Excellent analytical skills
• Working knowledge of appropriate coding systems; CPT, ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes
• Effective problem-solving skills in a fast paced and rapidly changing environment
• Excellent verbal and written communication skills
• Must be proficient in Microsoft Excel
• Quadax or Exemplar experience strongly desired

Pay range: $22 - $27/hr