Reimbursement, Reimbursement Specialist (Claim Denial & Appeal Focus)
About The Position
Castle Biosciences Inc. is growing, and we are looking to hire a Reimbursement Specialist (Claim Denial & Appeal Focus) working remotely from your home office based in the USA, with a start date of August 31, 2026. This individual is responsible for resolving denied insurance claims for laboratory services by providing payers with requested documentation, initiating the appeal process on behalf of the patient, following up on outstanding transactions, and delivering the highest level of customer service to internal and external customers. This role spends most of its time reviewing and resolving front-end claim issues to ensure timely, accurate submission; reviewing Explanation of Benefits (EOBs), electronic remittance advice, and denial letters; assigning ANSI codes; and taking appropriate action in the billing system. Responsibilities include contacting insurance companies for missing information or claim status, using payer portals for follow-up, and supplying additional documentation needed to adjudicate claims. The role also involves creating custom appeals with appropriate arguments to overturn denials based on payer medical policy or state laws and submitting both standard and custom appeal letters for insurance companies including Medicare, Medicare Advantage, and commercial plans.
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
- Must have a 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)
- Must demonstrate the ability to type 35 WPM with 90% or higher accuracy.
- All candidates must be legally authorized to work in the United States.
Responsibilities
- Resolving denied insurance claims for laboratory services by providing payers with requested documentation
- Initiating the appeal process on behalf of the patient
- Following up on outstanding transactions
- Delivering the highest level of customer service to internal and external customers
- Reviewing and resolving front-end claim issues to ensure timely, accurate submission
- Reviewing Explanation of Benefits (EOBs), electronic remittance advice, and denial letters
- Assigning ANSI codes
- Taking appropriate action in the billing system
- Contacting insurance companies for missing information or claim status
- Using payer portals for follow-up
- Supplying additional documentation needed to adjudicate claims
- Creating custom appeals with appropriate arguments to overturn denials based on payer medical policy or state laws
- Submitting both standard and custom appeal letters for insurance companies including Medicare, Medicare Advantage, and commercial plans
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
