Reimbursement Specialist

SUMMARY:

Decipher Biosciences, a subsidiary of Veracyte, Inc., is a dynamic entrepreneurial startup molecular diagnostics company focused on cancer genomics. Whether on the phone with patients, or in the cloud with big data, our innovators are working hard to give back to the patient what cancer takes away: information for life.

The successful candidate will be a rockstar at identifying, analyzing and resolving insurance company denials. While working with our Reimbursement, Commercial and Finance teams this role will provide on-going insight and analytics on all medical insurance claims.

ESSENTIAL DUTIES AND RESPONSIBILITIESL: include the following. Other duties may be assigned.

• Verifying insurance/recipient eligibility, billing and follow-up on claims to Medicare, Medicaid and Private Insurer Payers.
• Researching and responding to Medicare, Medicaid and other Payer inquiries regarding billing issues and insurance updates.
• Reviewing unpaid and/or denied claims, appeals and follow-up on accounts to zero status.
• Organizing and distribute comprehensive appeal packages to the insurance provider.
• Ability to review and interpret explanation of benefits to determine contractual allowance.
• Researching accounts and resolving deficiencies.
• Calling insurance companies regarding outstanding accounts. Utilize payor websites to check claim status.
• Reviewing and submitting accurate claims, re-submissions and claim review forms.
• Researching and monitoring specific billing issues, trends and potential risks based on current research and customer feedback.
• Answering all patient/doctor/hospital/lab/insurance company phone calls regarding accounts, and takes appropriate action.
• Providing administrative support (when requested) including performing data entry, updating various record keeping systems, upholding company policies and Client requirements, and participating in projects, duties, and other administrative tasks.
• Knowledge, understanding, and compliance with all applicable Federal and Local laws and regulations relating to job duties.
• Knowledge, understanding, and compliance with Company policies and procedures.

REQUIREMENTS: QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

• A university degree or a Certified Professional Coder or 2 yr Degree from Accredited Medical Billing School
• 3-5 Years of direct appeals and billing experience
• Enthusiasm and an entrepreneurial spirit
• Familiarity with ICD and HCPC/CPT coding preferred
• Familiarity with CMS 1500 claim form preferred
• Familiarity with Claim Adjustment Reason Codes (NUCC) preferred
• Use of personal computer, computer applications, and general office equipment including scanners.
• Ability to create and maintain spreadsheets
• Ability to use analytical, interpersonal, communication, organizational, numerical, and time management skills.
• Experience handling and expediting escalated issues, with follow up to the customer.
• Ability to quickly assess a situation and take appropriate actions to address customer needs and requests in a timely and efficient manner. Self-starter with the ability to work independently and effectively in a team environment.
• Ability to organize and prioritize multiple projects/tasks and meet deadlines in a constantly evolving and fast-paced environment.
• Strong, consistent work ethic with a keen attention to details and ability to focus on the big picture.
• Excellent written and verbal communication skills.
• Must be able to communicate with confidence and tact across all levels within the company.

PHYSICAL REQUIREMENTS

• Repetitive movement of hands, arms and legs
• Repetitive movement of fingers (typing and/or writing)
• Sitting, with occasional walking, standing, stooping and moving about
• Exposure to general office environment conditions
• Talking and hearing
• Occasionally required to lift up to 25 pounds

Equal Opportunity Employer: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.