Reimbursement Specialist
4 hours 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.
The Reimbursement Specialist position promotes efficient processing of eligibility, authorization, and obtaining medical records and documentation. Specialists play 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.
The CareDx current work model is hybrid, and will require the candidate to come onsite 3 days per week.
Responsibilities:- Confirming patient insurance coverage and benefits by contacting insurance companies or using electronic verification tools.
- Reviewing insurance policies to determine what services are covered, including deductibles, co-payments, and coverage limits.
- Accurately inputting patient and insurance information into billing systems and insurance billing tools (such as web-based portals).
- Submitting authorizations requests to insurance companies or other payers for approval of medical services or procedures.
- Interacting with various internal teams, healthcare providers, insurance companies, and patients to gather necessary information and facilitate the authorization process.
- Ensuring all authorizations adhere to government, regulatory, and payer guidelines and standards.
- Identifying and addressing issues related to denied or delayed authorizations and finding alternative solutions when necessary.
- Developing strategies to mitigate these problems.
- Keeping detailed records of eligibility verification and communications with insurance companies.
- Gathering and providing necessary documentation, such as medical records or treatment plans, to support authorization requests or claims submissions.
- Monitoring the status of authorization requests and follow-up with insurance companies to ensure timely processing and approval.
- Explaining laboratory insurance benefits, coverage, policy requirements, and filing rules to patients.
- Informing patients about their coverage, out-of-pocket costs, and any potential financial responsibilities.
- Participating in staff and company meetings and events.
- Recommending innovative approaches, suggestions in policies, and procedures to effect continual improvements in the efficiency of the 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.
- 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.
- Ability to maintain a professional and confidential working environment.
- Ability 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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