Reimbursement Specialist at CareDx

Brisbane, CAFull-timeGENERAL & ADMINISTRATIVEPosted 14 days ago

About the Role

<div class="content-intro"> </div>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 primary responsibility of the Insurance Reimbursement Specialist is to maximize reimbursement by collecting outstanding balances from insurance companies. The Specialist will maximize collections by following up on unresolved claims and appeals, and by escalating claims for reconsiderations and up to three levels of appeals. The Specialist will work closely with the CareDx Payer Dispute Resolution and Market Access teams to ensure CareDx receives coverage and appropriate reimbursement from contracted and non-contracted payers and government health plans. This role requires meticulous work and the ability to thrive in a fast-paced environment. This is a full-time position, Monday through Friday, with occasional overtime as needed. Candidates within commuting distance of the Brisbane, California office will need to come to the office on a regular basis; remote candidates will work and collaborate from home. Responsibilities: Claim Follow-up: <ul> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Resolve aged claims and appeals without payer responses via payer portals & outbound phone calls.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Identify claims that need a first, second, or third level appeal.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Assist teammates with projects and denial work queue management.</li> </ul> Denials and appeals: <ul> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Prioritize an assigned work queue to ensure timely work is balanced with working the most payable claims.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Identify non-payment trends and, in collaboration with Revenue Cycle leadership, escalate groups of claims to the CareDx Payer Dispute </li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Resolution or Market Access teams.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Investigate denial and non-payment trends identified by the Revenue Cycle Analytics team. Propose solutions and collaborate cross-functionally with the Denials Management Steering Committee.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Share opportunities to improve upstream work to prevent denials.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Work with patients when their assistance is needed in the appeal process.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Work professionally with Revenue Cycle teammates to be responsive to requests that require your assistance.</li> </ul> Qualifications: <ul> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Education: High school diploma or equivalent.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Experience: 3-5 years’ experience in medical billing; strong preference will be given to candidates with molecular laboratory billing experience. Medical billing experience may be substituted with a bachelor’s degree.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Understanding of patient protections under HIPAA and proper handling of protected health information (PHI).</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Working knowledge of health insurance and terminology.  </li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Excellent communication and people skills.</li> <li style="font-family: 'times new roman', times, serif; font-size: 12pt;">Meticulous with strong analytical and problem-solving abilities.</li> </ul>   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 for US Employees includes: <ul> <li style="font-size: 12pt; font-family: 'times new roman', times, serif;">Competitive base salary and incentive compensation</li> <li style="font-size: 12pt; font-family: 'times new roman', times, serif;">Health and welfare benefits, including a gym reimbursement program</li> <li style="font-size: 12pt; font-family: 'times new roman', times, serif;">401(k) savings plan match</li> <li style="font-size: 12pt; font-family: 'times new roman', times, serif;">Employee Stock Purchase Plan</li> <li style="font-size: 12pt; font-family: 'times new roman', times, serif;">Pre-tax commuter benefits</li> <li style="font-size: 12pt; font-family: 'times new roman', times, serif;">And more!</li> <li style="font-size: 12pt; font-family: 'times new roman', times, serif;">Please refer to our page to view detailed benefits at <a href="https://caredx.com/company/careers/" target="_blank">https://caredx.com/company/careers</a></li> </ul> 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’s 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. By proceeding with our application and submitting your information, you acknowledge that you have read our <a href="https://nam04.safelinks.protection.outlook.com/?url=http%3A%2F%2Fcaredx.com%2Fus-personnel-privacy-notice%2F&data=05%7C02%7C%7C82daf31a87e44746b2ea08dceef5e348%7C9ec77d4e480144b4b8fea5749eaf06b0%7C1%7C0%7C638647987067912610%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=2m6s48ae9FuUbrhudLltyYwmxkwF09q91VSr94Shslg%3D&reserved=0" target="_blank">U.S. Personnel Privacy Notice</a><a href="https://nam04.safelinks.protection.outlook.com/?url=http%3A%2F%2Fcaredx.com%2Fus-personnel-privacy-notice%2F&data=05%7C02%7C%7C82daf31a87e44746b2ea08dceef5e348%7C9ec77d4e480144b4b8fea5749eaf06b0%7C1%7C0%7C638647987067924758%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=fvNqQdyyA0YaWb3Y4bxHjbbzsxfJ4EmKAEMFQr39KnU%3D&reserved=0" target="_blank"> </a>and consent to receive email communication from CareDx. ***We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.*** Certain jurisdictions require notice of how we use and protect your personal information. For more information, please read our <a href="https://caredx.com/privacy-center/#ca-privacy">Privacy Policy</a> #LI-Remote<div class="content-pay-transparency"><div class="pay-input"><div class="description">This is the anticipated base salary range in the United States. The final salary offered to a successful candidate will be dependent on several factors that may include, but are not limited to, the type and length of experience within the job, the type and length of experience within the industry, education, etc. Base pay is one part of the Total Package that is provided to compensate and recognize employees for their work, and this role may be eligible for additional discretionary bonuses/incentives and restricted stock units. CareDx is a multi-state employer, and this salary range may not reflect positions that work in other states.</div><div class="title">Remote: US only roles</div><div class="pay-range">$26—$33 USD</div></div></div>

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