Reimbursement Specialist

4 days ago

Brisbane, California, United States CareDx, Inc. Full time
Job Title: Reimbursement Specialist

CareDx, Inc. is a leading precision medicine solutions company focused on delivering innovative healthcare solutions for transplant patients and caregivers. As a Reimbursement Specialist, you will play a critical role in managing and processing payments received from insurance companies, patients, or other healthcare providers for healthcare services provided to them.

Key Responsibilities:
  • Remittance Posting: Accurately enter payments and adjustments into the billing system or electronic health records (EHR) based on remittance advice.
  • Payment Reconciliation: Ensure that payments are correctly applied to patient accounts and reconcile any discrepancies between billed amounts and received payments.
  • Claim Resolution: Review remittance advice to identify and address denied or underpaid claims, translating letter format correspondence into standard remittance advice codes.
  • Record Maintenance: Maintain up-to-date records of payments, adjustments, and account statuses.
  • Interdepartmental Collaboration: Interact with various internal teams, banks, healthcare providers, insurance companies, and patients to resolve payment-related issues and optimize revenue cycle processes.
  • Regulatory Compliance: Ensure that all remittance posting activities adhere to regulatory standards and payer requirements, adhering to HIPAA, PHI, and confidentiality laws and guidelines.
  • Payment Analysis: Identify and address issues related to delayed payment application and develop strategies to mitigate these problems.
  • Reporting: Create reports on payment activity, adjustments, and outstanding balances to assist in financial analysis and decision-making.
Qualifications:
  • Education: High School Diploma or equivalent.
  • Medical Terminology: Proficiency in medical terminology, healthcare billing codes (CPT, HCPCS, ICD), and payer policies.
  • Software Proficiency: 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.
  • Attention to Detail: Efficiently manage remittance posting tasks, maintain accurate financial records, and support the overall revenue cycle process.
  • Regulatory Knowledge: Understanding of regulatory compliance and insurance reimbursement processes is essential.
  • Previous Experience: Previous experience in healthcare billing, coding, claims processing, particularly in diagnostic laboratory services, is highly valued.
  • Independence: Ability to work independently with minimal supervision.
  • Problem-Solving: Capability to identify issues and develop effective solutions.
  • Communication: Strong written and verbal communication skills.
About CareDx, Inc.

CareDx, Inc. is an Equal Opportunity Employer and participates in the E-Verify program. We offer a competitive Total Rewards package, including a base salary, incentive compensation, health and welfare benefits, 401(k) savings plan match, Employee Stock Purchase Plan, pre-tax commuter benefits, and more. We also have a Living Donor Employee Recovery Policy that allows up to 30 days of paid leave annually to a full-time employee who makes the selfless act of donating an organ or bone marrow.

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