Senior Clinical Reimbursement Specialist

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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 for complex cases • Own end-to-end resolution of assigned cases, including follow-up, provider coordination, and escalation • Coordinate peer-to-peer reviews and gather supplemental clinical documentation and Authorized Representative forms and signatures • Mentor and provide informal guidance to Clinical Reimbursement Specialists • Analyze denial patterns and appeal outcomes, identify root causes, and drive feedback to 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 partner with leadership on 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 • Ability to independently manage complex, ambiguous, or high-dollar cases • Ability to translate payer medical policy criteria into patient-specific clinical justification • Strong critical thinking and analytical skills • Experience developing SOPs, appeal letter templates, workflow tools, or operational assets • Ability to mentor or provide informal leadership to peers • Excellent communication and collaboration skills • Ability to own cases through resolution and work effectively amid shifting priorities and ambiguity • Preferred: experience in oncology diagnostics, laboratory services, specialty reimbursement, process improvement, workflow redesign, healthcare automation/AI, or relevant certification/master's degree

🏖️ Benefits

• Competitive compensation and benefits • Potential eligibility for additional discretionary bonuses/incentives • Potential eligibility for restricted stock units • Career opportunities and opportunities to learn and grow • Inclusive workforce and workplace • Recognition as a 2024 Certified Great Place to Work in the US and Israel