Reimbursement Support Specialist-IVD

Cleveland Diagnostics•Cleveland, OH

8d•Remote

About The Position

Reimbursement Support Specialist- IVD Products supports the company’s compliance with federal and state laws by preparing and distributing accurate billing and reimbursement educational materials related to in-vitro diagnostic (IVD) test kits. This role involves communicating reimbursement information to customers, assisting with provider education, and ensuring all activities align with regulatory requirements and internal policies.

Requirements

Knowledge of medical billing and coding systems, including CPT, HCPCS, ICD-10, and CMS fee schedules.
Familiarity with federal regulations affecting healthcare reimbursement, including FDA, CMS, Anti-Kickback, False Claims Act, and HIPAA rules.
Microsoft Excel proficiency
Solid analytical, mathematical, and research skills
Great interpersonal skills
Excellent communication skills (written and verbal)
Strong attention to detail and highly organized
Ability to handle multiple demands and to respond rapidly to changing priorities
Commitment to ethical standards and regulatory compliance.

Nice To Haves

Bilingual (English/Spanish) preferred.
Associates Degree in Business Administration or Health Information Management preferred or equivalent work experience of 3 years in Revenue Cycle Management

Responsibilities

Provide timely and accurate support to customer inquiries via telephone and email.
Share publicly available coverage determinations such as Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and commercial payer policies.
Monitor and report status of individual Medicare Administrative Contractor (Mac) Local Coverage Determination applications.
Develop and distribute customized appeal templates incorporating peer-reviewed publications and NCCN guideline inclusions to support medical necessity.
Provide reporting on payer-specific LDT claim trends including denial and appeal resolution metrics.
Ensure all billing and reimbursement content is accurate, based solely on publicly available payer information.
Include standard disclaimers highlighting payer variations and emphasizing provider responsibility for coding and billing decisions.
Document all client interactions, inquiries, and resolutions accurately in the CRM system.
Promptly report any suspected violations of the company’s reimbursement policies or applicable laws to the Compliance Officer or confidential hotline.
Participate in periodic reviews and updates of reimbursement materials to ensure continued regulatory compliance.
Perform other duties as assigned to support team goals and operational needs.

Benefits

100% Employer-paid medical for single coverage effective on your date of hire and 50% employer-paid medical for spouse/dependent coverage
100% Employer-paid Dental & Vision for entire family
No cost for employee coverage for Group Term Life, Short & Long Term Disability
4% retirement contribution Employer match
Incentive Performance Plan & Stock Option Program & Commission (Sales Account Execs)
Paid Family Leave Program
Generous PTO plan & holiday program
Flexible work schedule & lucrative employee referral program
Salary range may vary by work state/geographical region/territory
Easy to get to office location with newly built-out office space
Free coffee, snacks and other goodies all day long