Clinical Reimbursement Expert

1 week ago

Brisbane, California, United States CareDx, Inc. Full time

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.

Key Responsibilities:
  • We are seeking an experienced Clinical Reimbursement Expert to promote efficient processing of eligibility, authorization, and obtaining medical records and documentation.
  • The ideal candidate will play a critical role in ensuring timely and accurate payment is received, 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.
What You'll Do:
  1. Confirm patient insurance coverage and benefits by contacting insurance companies or using electronic verification tools.
  2. Accurately input patient and insurance information into billing systems and insurance billing tools (such as web-based portals).
  3. Submit authorizations requests to insurance companies or other payers for approval of medical services or procedures.
  4. Interact with various internal teams, healthcare providers, insurance companies, and patients to gather necessary information and facilitate the authorization process.
  5. Evaluate all authorizations to ensure they adhere to government, regulatory, and payer guidelines and standards, maintaining confidentiality and adhering to HIPAA laws.
  6. Analyze issues related to denied or delayed authorizations and develop effective strategies to mitigate these problems.
  7. Maintain detailed records of eligibility verification and communications with insurance companies, gathering necessary documentation to support authorization requests or claims submissions.
  8. Monitor the status of authorization requests and follow up with insurance companies to ensure timely processing and approval.
  9. Communicate effectively with patients about their laboratory insurance benefits, coverage, policy requirements, and filing rules.
  10. Participate in staff and company meetings and events.
  11. Recommend innovative approaches, suggestions in policies, and procedures to effect continual improvements in the efficiency of department operations.
About You:
  • You require a High School Diploma or equivalent.
  • Proficiency in medical terminology, healthcare billing codes (CPT, HCPCS, ICD), and payer policies.
  • Proficiency with healthcare management software, claims processing systems, Electronic Health Records (EHR), Electronic Medical Records (EMR), and insurance websites.
  • Understanding of regulatory compliance and insurance reimbursement processes.
  • Prior experience in healthcare billing, coding, claims processing, particularly in diagnostic laboratory services, is highly valued.
  • Excellent organizational and communication skills to effectively manage the authorization process.
  • Ability to work independently with minimal supervision.
  • Capability to identify issues and develop effective solutions.
  • Able to maintain a professional and confidential working environment.
  • Strong written and verbal communication skills.
Salary and Benefits:

$85,000 - $105,000 per year

Our competitive Total Rewards package includes:

  • Competitive base salary and incentive compensation.
  • Health and welfare benefits including a gym reimbursement program.
  • 401(k) savings plan match.
  • Employee Stock Purchase Plan.
  • Pre-tax commuter benefits.
  • And more
Company Culture:

CareDx has a direct impact on our collective mission to improve the lives of organ transplant patients worldwide. We believe in taking great care of our people, so they take even greater care of our patients.

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