Reimbursement, Reimbursement Specialist (Medical Records Focus)
About The Position
Castle Biosciences is seeking to hire a Reimbursement Specialist (Medical Records Focus) to work remotely from a home office based in the USA. This individual is responsible for resolving insurance claims for laboratory test services that require medical record documentation. This involves requesting records from clinician offices, following up on those requests, and submitting complete medical records to payers based on their requirements, medical policy, or state laws, while providing excellent customer service. The role requires significant communication with ordering clinicians and their staff via phone, fax, and email to obtain necessary patient medical records, analyzing received records for completeness, and securing any missing information. Additional duties include preparing medical record cover letters, submitting documentation to demonstrate medical necessity or compliance with medical policy criteria, creating custom submission letters with arguments to support claim processing, and contacting patients, physician offices, or sales to gather remaining required information.
Requirements
- High School Diploma or equivalent GED or equivalent work experience
- Two years of health insurance billing with experience in identifying and resolving claim issues for laboratory tests
- Working knowledge of various payers' designations of authorized representative forms
- Experience handling a high volume of claims work on a daily basis (35 plus claims per day)
- Ability to type 35 WPM with 90% or higher accuracy
- Must be legally authorized to work in the United States
Responsibilities
- Resolving insurance claims for laboratory test services that require medical record documentation
- Requesting medical records from clinician offices
- Following up on requests for medical records
- Submitting complete medical records to payers based on their requirements, medical policy, or state laws
- Communicating with ordering clinicians and their staff via phone, fax, and email to obtain necessary patient medical records
- Analyzing received records to ensure all required documentation is included
- Securing any missing information
- Preparing medical record cover letters
- Submitting documentation to demonstrate medical necessity or compliance with medical policy criteria
- Creating custom submission letters with arguments that support claim processing according to payer policy, state laws, or Medicare regulations
- Contacting patients, physician offices, or sales to gather any remaining required information
Benefits
- 20% Bonus Potential
- 20 Accrued PTO Days Annually
- 10 Paid Holidays
- 401K with 100% Company Match up to 6%
- 3 Health Care Plan Options
- Company HSA Contribution
- Company Stock Grant Upon Hire
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
