Reimbursement Specialist
3 weeks ago
CareDx, Inc. is a leading precision medicine solutions company focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients and caregivers.
Job SummaryThe Reimbursement Specialist position plays a critical role in ensuring timely and accurate payment is received. This includes working with insurance companies, healthcare providers, and patients to obtain accurate identification numbers and eligibility information and claim status via the Internet and/or phone.
Key Responsibilities- Submit claims with the proper documentation to insurance providers timely for prompt payment
- Knowledge of interpreting an explanation of benefits or payment
- Analyzing denied or rejected claims to determine root cause and appropriate next course of action
- Drafting and submitting appeal letters and documentation. Submitting to insurance companies to contest denied claims via web-based portal, fax, or mail.
- Interacting with various internal teams, healthcare providers, insurance companies and patients to gather necessary information and resolve issues.
- Ensuring all claims and appeals adhere to government, regulatory and payer guidelines and standards. Adhere to HIPPA, PHI and confidentiality laws and guidelines.
- Identifying and addressing systemic issues that contribute to claim denials. Develop strategies to mitigate these problems
- Maintaining detailed records of claim and appeal processes, including correspondence and outcomes.
- Monitoring the status of submitted claims or appeals and ensuring timely resolution
- Explain laboratory insurance benefits, coverage, policy requirements, and filing rules to patients
- Participates in staff and company meetings and events
- Recommends innovative approaches, suggestions in policies, and procedures to effect continual improvements in the efficiency of department
- Requires a High School Diploma or equivalent.
- Proficiency in medical terminology, healthcare billing codes (CPT, HCPCS, ICD) and payer policies.
- Proficiency with healthcare management software (such as Telcor, XiFin, and QuadX), claims processing systems, Electronic Health Records (EHR), Electronic Medical Records (EMR) and insurance websites.
- Understanding of regulatory compliance and insurance reimbursement processes is essential.
- Previous experience in healthcare billing, coding, claims processing, particularly in diagnostic laboratory services, is highly valued.
- Ability to review and interpret complex data and claims denials.
- Must have the ability to work independently with minimal supervision.
- Capability to identify issues and develop effective solutions.
- Must be able to maintain a professional and confidential working environment.
- Must be able to analyze, summarize and provide details of findings when needed.
- Strong written and verbal communication skills.
CareDx, Inc. is an Equal Opportunity Employer and participates in the E-Verify program.
By proceeding with our application and submitting your information, you acknowledge that you have read our U.S. Personnel Privacy Notice and consent to receive email communication from CareDx.
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