Revenue Cycle Reimbursement Specialist

Veracyte, Inc.; San Diego (CA); Remote; USD 50,000 - 75,000; Full time

Job summary

A leading company in the healthcare sector is seeking an Insurance Claims Analyst to join their team. This remote position involves analyzing and resolving insurance denials, collaborating with various departments, and ensuring compliance with regulations. Ideal candidates will have a degree or certification in medical billing, along with strong analytical and communication skills. This full-time role offers a dynamic work environment with opportunities for professional growth.

Qualifications

• 1-2 years of experience in appeals and billing.
• Familiarity with ICD, HCPCS/CPT coding, CMS 1500 claim forms.
• Proficiency with computers and spreadsheets.

Responsibilities

• Verifying insurance eligibility and billing.
• Managing appeals and following up on accounts.
• Providing administrative support and ensuring compliance.

Skills

Analytical skills

Interpersonal skills

Communication skills

Organizational skills

Time management

Education

University degree

Certified Professional Coder

2-year degree from accredited medical billing school

Job description

Position Overview:

The successful candidate will excel at identifying, analyzing, and resolving insurance company denials. This role involves collaborating with our Reimbursement, Commercial, and Finance teams to provide ongoing insights and analytics on medical insurance claims. This is a U.S. remote position.

* This is a full-time, non-exempt position with a schedule of Monday through Friday, 8:30am-5pm PST.

Responsibilities include:

• Verifying insurance/recipient eligibility, billing, and follow-up on claims to Medicare, Medicaid, and Private Insurers.
• Researching and responding to inquiries from Medicare, Medicaid, and other payers regarding billing issues and insurance updates.
• Reviewing unpaid and denied claims, managing appeals, and following up on accounts to achieve zero balance.
• Organizing and distributing comprehensive appeal packages to insurance providers.
• Reviewing and interpreting explanations of benefits to determine contractual allowances.
• Researching accounts and resolving deficiencies.
• Calling insurance companies regarding outstanding accounts and utilizing payor websites to check claim status.
• Reviewing and submitting accurate claims, re-submissions, and claim review forms.
• Monitoring billing issues, trends, and risks based on research and customer feedback.
• Handling all calls from patients, doctors, hospitals, labs, and insurance companies regarding accounts, and taking appropriate actions.
• Providing administrative support, including data entry, updating records, and participating in projects and other tasks.
• Ensuring compliance with all applicable federal and local laws, regulations, company policies, and procedures.
• Performing other duties as assigned.

Qualifications:

• University degree, Certified Professional Coder, or 2-year degree from an accredited medical billing school.
• 1-2 years of experience in appeals and billing.
• Enthusiasm and an entrepreneurial spirit.
• Familiarity with ICD, HCPCS/CPT coding, CMS 1500 claim forms, and Claim Adjustment Reason Codes (NUCC) is preferred.
• Proficiency with computers, spreadsheets, and office equipment.
• Strong analytical, interpersonal, communication, organizational, and time management skills.
• Experience handling escalated issues and following up with customers.
• Ability to assess situations quickly and work independently and in teams.
• Excellent attention to detail and the ability to focus on the big picture.
• Effective communication skills across all levels of the organization.