Overview
A precision medicine solutions company specializing in healthcare for transplant patients is seeking an Insurance Reimbursement Specialist. This role focuses on maximizing reimbursement by managing outstanding insurance balances, following up on unresolved claims and appeals, and escalating claims through multiple levels of appeal. The specialist will collaborate closely with payer dispute resolution and market access teams to ensure appropriate coverage and reimbursement from both contracted and non-contracted payers, including government health plans.
This is a full-time position, Monday through Friday, with occasional overtime as needed. Candidates located near Brisbane, California are expected to work regularly from the office; remote candidates will work from home within the US.
Responsibilities
- Resolve aged claims and appeals through payer portals and outbound phone calls.
- Identify claims requiring first, second, or third level appeals.
- Assist team members with projects and denial work queue management.
- Prioritize assigned work queues to balance timely processing with focusing on the most payable claims.
- Identify non-payment trends and escalate groups of claims to payer dispute resolution or market access teams.
- Investigate denial and non-payment trends in collaboration with revenue cycle analytics and propose solutions.
- Collaborate cross-functionally with denial management committees to improve processes.
- Share opportunities to improve upstream work to prevent denials.
- Work with patients when their assistance is needed during the appeal process.
- Respond professionally and promptly to requests from revenue cycle teammates.
Requirements
- High school diploma or equivalent.
- 3-5 years of medical billing experience; molecular laboratory billing experience is strongly preferred.
- Bachelor’s degree may substitute for medical billing experience.
- Understanding of patient protections under HIPAA and proper handling of protected health information (PHI).
- Working knowledge of health insurance and related terminology.
- Excellent communication and interpersonal skills.
- Strong analytical, meticulous, and problem-solving abilities.
Compensation & Benefits
- Base salary range: $26 to $33 USD per hour (U.S. based roles).
- Competitive base salary with incentive compensation.
- Health and welfare benefits, including a gym reimbursement program.
- 401(k) savings plan with employer match.
- Employee Stock Purchase Plan.
- Pre-tax commuter benefits.
- Additional discretionary bonuses/incentives and restricted stock units may be available.
- Paid leave policy for living organ or bone marrow donors (up to 30 days annually).
Location
- Position available for candidates within the United States.
- Candidates near Brisbane, California expected to work onsite regularly.
- Remote work option available for U.S. candidates.
This role requires meticulous attention to detail and the ability to thrive in a fast-paced environment. The successful candidate will play a key role in ensuring appropriate reimbursement for healthcare services related to transplant patients.