Reimbursement Specialist - Claims and Appeals

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. CareDx offers products, testing services, and digital healthcare solutions along the pre- and post-transplant patient journey, and is the leading provider of genomics-based information for transplant patients.

The Reimbursement Specialist position promotes efficient processing of claims and appeals and 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.

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

Qualifications:

• 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

Additional Details:

Every individual at 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.

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!

In addition, we 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.

With products that are making a difference in the lives of transplant patients today and a promising pipeline for the future, it is an exciting time to be part of the CareDx team. Join us in partnering with transplant patients to transform our future together.

CareDx, Inc. is an Equal Opportunity Employer and participates in the E-Verify program.

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