Senior Clinical Reimbursement Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $86.1k - $137.7k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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Veracyte, Inc.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

🏥 Healthcare

🧬 Biotechnology

⚕️ Healthcare Insurance

Healthcare • Biotechnology • Healthcare Insurance

Veracyte, Inc. is a genomic diagnostics company focused on empowering clinicians with high-value molecular tests for diagnosing and treating cancer. The company provides a portfolio of genomic classifiers for various types of cancer, including thyroid, prostate, lung, breast, and bladder cancer, as well as interstitial lung disease. Veracyte's tests help clinicians and patients make informed decisions about cancer care by providing clear diagnostic and prognostic insights. The company's approach involves identifying unmet clinical needs and developing high-performance tests that are widely accessible globally through a CLIA and in vitro diagnostic-based model. Committed to elevating the standard of cancer care, Veracyte continues to expand its test portfolio and make significant contributions to the field of oncology diagnostics.

📋 Description

• Independently manage complex pre- and post-service appeals across Level 1, Level 2, and external review pathways • Review, develop, and submit clinically robust appeal documentation • Serve as a clinical subject matter expert on payer medical policies and guide appeal strategy • Own end-to-end resolution of assigned cases, including follow-up and escalation • Coordinate peer-to-peer reviews and gather supplemental clinical documentation with ordering physicians and practice staff • Secure Authorized Representative forms and signatures • Mentor Clinical Reimbursement Specialists through case review, feedback, and coaching • Analyze denial patterns and appeal outcomes to identify root causes and reduce future denials • Develop and refine appeal letter templates, clinical evidence packets, payer reference guides, and operational tools • Monitor payer behavior and policy changes and support remediations, coverage reviews, and payer escalations • Maintain and improve SOPs for consistent, compliant, and scalable workflows • Handle complex patient- or provider-facing inquiries • Support automation and AI/agentic workflow pilots • Represent the Clinical Reimbursement team in cross-functional initiatives and special projects

🎯 Requirements

• Active clinical licensure (e.g., RN, NP) • Associate or Bachelor's degree in nursing • 3–5 years of experience in healthcare reimbursement, revenue cycle operations, or payer-facing roles • 2+ years of experience in prior authorization, denial management, or appeals, including pre-service and post-service workflows • Advanced understanding of payer medical policies, prior authorization, claims adjudication, denials, and appeals, including Level 1, Level 2, and external review processes • Ability to independently manage complex, ambiguous, or high-dollar cases without routine escalation • Ability to translate complex payer medical policy criteria into patient-specific clinical justification • Strong critical thinking and analytical skills • Experience contributing to SOPs, appeal letter templates, workflow tools, or other operational assets within a reimbursement environment • Ability to mentor or provide informal leadership to peers • Excellent communication and collaboration skills • Ability to work in an evolving environment with shifting priorities and ambiguity • Preferred: experience in oncology diagnostics, laboratory services, or complex/specialty reimbursement environments • Preferred: process improvement, workflow redesign, or operational scaling experience • Preferred: familiarity with healthcare automation, AI/agentic workflows, workflow tools, or system integration • Preferred: CPC, CRCR, CHFP, Lean/Six Sigma certification or Master's degree

🏖️ Benefits

• Competitive compensation and benefits • Eligibility for additional discretionary bonuses/incentives • Restricted stock units • Career opportunities and opportunities for growth • Inclusive workforce and workplace