Reimbursement Specialist

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:

• Resolve aged claims and appeals without payer responses via payer portals & outbound phone calls.
• Identify claims that need a first, second, or third level appeal.
• Assist teammates with projects and denial work queue management.

Denials and appeals:

• Prioritize an assigned work queue to ensure timely work is balanced with working the most payable claims.
• Identify non-payment trends and, in collaboration with Revenue Cycle leadership, escalate groups of claims to the CareDx Payer Dispute
• Resolution or Market Access teams.
• 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.
• Share opportunities to improve upstream work to prevent denials.
• Work with patients when their assistance is needed in the appeal process.
• Work professionally with Revenue Cycle teammates to be responsive to requests that require your assistance.

Qualifications:

• Education: High school diploma or equivalent.
• 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.
• Understanding of patient protections under HIPAA and proper handling of protected health information (PHI).
• Working knowledge of health insurance and terminology.  
• Excellent communication and people skills.
• Meticulous with strong analytical and problem-solving abilities.

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:

• 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!
• Please refer to our page to view detailed benefits at https://caredx.com/company/careers

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.

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