Reimbursement, Reimbursement Specialist (Medical Records Focus)(Remote)

Castle Biosciences•Friendswood, TX

30d•$46,000 - $47,277•Remote

About The Position

Castle Biosciences Inc. is growing, and we are looking to hire a Reimbursement Specialist (Medical Records Focus) working remotely from your home office based in the USA, with a start date on or before January 15, 2026. This individual is responsible for resolving insurance claims for laboratory test services that require medical record documentation by 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 the highest level of customer service to internal and external customers. This role spends most of its time communicating with ordering clinicians and their staff via phone, fax, and email to obtain the necessary patient medical records, analyzing received records to ensure all required documentation is included, and securing any missing information. Additional responsibilities include preparing medical record cover letters and submitting documentation to demonstrate medical necessity or compliance with medical policy criteria. When needed, this individual creates custom submission letters with arguments that support claim processing according to payer policy, state laws, or Medicare regulations, and contacts patients, physician offices, or sales to gather any remaining required information.

Requirements

High School Diploma or equivalent, GED, or equivalent work experience.
Two years of health insurance billing with experience in reviewing medical records, extracting key details, and populating custom medical records submissions to payers.
Must have in-depth experience reading and interpreting medical record documents and payer medical policies to ensure the medical documents contain the key "medical necessity" criteria required and meet CMS medical documentation requirements.
Experience handling a high volume of claims work on a daily basis (32 plus claims per day)
Must demonstrate the ability to type 35 WPM with 90% or higher accuracy.

Responsibilities

Resolving insurance claims for laboratory test services that require medical record documentation
Requesting records from clinician offices
Following up on record requests
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 the necessary patient medical records
Analyzing received records to ensure all required documentation is included
Securing any missing information
Preparing medical record cover letters and 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