Insurance Reimbursement Specialist
About The Position
CareDx is a leading precision medicine diagnostics company advancing care in transplant, specialty oncology, and cell therapy. Through our innovative portfolio of molecular diagnostics, digital health solutions, AI-powered data and analytics, and patient support services, we partner with healthcare providers, patients, and biopharma organizations to help inform clinical decision-making and improve patient outcomes. At CareDx, every employee has the opportunity to contribute to innovations that help transform patient care and improve lives. The primary responsibility of the Insurance Reimbursement Specialist is to maximize reimbursement by collecting outstanding balances from insurance companies. The Specialist will maximize collections by following up on unresolved claims and appeals, and by escalating claims for reconsiderations and up to three levels of appeals. The Specialist will work closely with the CareDx Payer Dispute Resolution and Market Access teams to ensure CareDx receives coverage and appropriate reimbursement from contracted and non-contracted payers and government health plans. This role requires meticulous work and the ability to thrive in a fast-paced environment. This is a full-time position, Monday through Friday, with occasional overtime as needed. Candidates within commuting distance of the Brisbane, California office will need to come to the office on a regular basis; remote candidates will work and collaborate from home.
Requirements
- High school diploma or equivalent.
- 3-5 years’ experience in medical billing; strong preference will be given to candidates with molecular laboratory billing experience. Medical billing experience may be substituted with a bachelor’s degree.
- Understanding of patient protections under HIPAA and proper handling of protected health information (PHI).
- Working knowledge of health insurance and terminology.
- Excellent communication and people skills.
- Meticulous with strong analytical and problem-solving abilities.
Nice To Haves
- Molecular laboratory billing experience
Responsibilities
- Resolve aged claims and appeals without payer responses via payer portals & outbound phone calls.
- Identify claims that need a first, second, or third level appeal.
- Assist teammates with projects and denial work queue management.
- Prioritize an assigned work queue to ensure timely work is balanced with working the most payable claims.
- Identify non-payment trends and, in collaboration with Revenue Cycle leadership, escalate groups of claims to the CareDx Payer Dispute Resolution or Market Access teams.
- Investigate denial and non-payment trends identified by the Revenue Cycle Analytics team. Propose solutions and collaborate cross-functionally with the Denials Management Steering Committee.
- Share opportunities to improve upstream work to prevent denials.
- Work with patients when their assistance is needed in the appeal process.
- Work professionally with Revenue Cycle teammates to be responsive to requests that require your assistance.
Benefits
- Competitive base salary and incentive compensation
- Health and welfare benefits, including a gym reimbursement program
- 401(k) savings plan match
- Employee Stock Purchase Plan
- Pre-tax commuter benefits
- Living Donor Employee Recovery Policy (up to 30 days of paid leave annually for organ or bone marrow donation)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
