Insurance lead

Serova; San Francisco (CA); On-site; USD 90,000 - 140,000; Full time

Job summary

Serova seeks a payer strategist to secure coverage for tests, therapies and referrals, and to navigate prior authorizations, appeals and denials. You will build our longer-term payer strategy for diagnostics and therapies, while explaining costs to patients and families and coordinating with patient case managers.

Your work will help patients access treatment and ensure billing aligns with plans, in a fast-paced startup environment in SF or London.

Qualifications

• Experience with US health insurance from the provider or payer side.
• Hands-on with prior authorizations, appeals and denials.
• Based in the San Francisco Bay Area or London, or willing to relocate.
• Comfortable working US hours if based in London.
• Authorized to work in the US or UK, or a realistic path to get there.

Responsibilities

• Get our tests, therapies and referrals covered by patients' insurers.
• Handle prior authorizations, appeals and denials, case by case.
• Work out what is reimbursable, including billable specialist consultations, and tell the rest of the company early.
• Work with our patient case managers on the cost side of each case.
• Help patients understand what they'll pay and what their plan covers.
• Build our longer-term payer strategy for our own diagnostics and therapies.

Skills

US health insurance knowledge

Prior authorizations

Appeals & denials

Cost explanation to patients

Job description

About Serova

Serova builds personalized cancer vaccines and helps patients reach the best treatments available, anywhere in the world. Each vaccine is made for the individual patient from their own samples and given in partnership with their treating physician. Most of what we offer is new, so getting it paid for is part of getting it to patients.

The role

Most of what we help patients get isn't routinely covered. You've work out how to get it paid for, case by case, and build our longer-term payer strategy.

What you'll do

• Get our tests, therapies and referrals covered by patients' insurers
• Handle prior authorizations, appeals and denials, case by case
• Work out what is reimbursable, including billable specialist consultations, and tell the rest of the company early
• Work with our patient case managers on the cost side of each case
• Help patients understand what they'll pay and what their plan covers
• Build our longer-term payer strategy for our own diagnostics and therapies

Who you are

• You know US insurance from the inside and don't give up after a denial
• You explain cost clearly to patients and families
• High agency, warm and low ego

Requirements

• Experience with US health insurance from the provider or payer side
• Hands-on with prior authorizations, appeals and denials
• Based in the San Francisco Bay Area or London, or willing to relocate
• Comfortable working US hours if based in London
• Authorized to work in the US or UK, or a realistic path to get there

What will make you stand out

• Oncology or specialty coverage
• Coverage for treatment outside standard of care
• Billing for specialist services, such as consultations
• Payer strategy for a new diagnostic or therapy
• Startup experience: you've built a process rather than inherited one

Details

• Location: San Francisco or London
• Type: Full-time