Senior Clinical Reimbursement Specialist

Veracyte, Inc.; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

Scorpion Therapeutics seeks an experienced health-care reimbursement professional to independently manage high-dollar appeals and translate payer policies into clinical justification. You will coordinate with providers and mentor team members to strengthen the reimbursement process.

You will analyze denial patterns, contribute to workflow and SOP development, monitor payer policy changes, and support digital transformation initiatives to improve overturn rates and revenue.

Qualifications

• Active clinical licensure (RN/NP)
• 3–5 years in healthcare reimbursement
• Experience with appeals and denials
• Deep understanding of payer medical policies and claims adjudication

Responsibilities

• Independently handle high-dollar and ambiguous appeals
• Translate payer policies into clinical justification
• Coordinate with providers
• Mentor team members
• Drive process improvements to improve overturn rates and revenue
• Analyze denial patterns
• Support workflow and SOP development
• Monitor payer policy changes
• Support digital transformation initiatives

Skills

RN/NP license

Healthcare reimbursement

Appeals & denials

Payer policies

Claims adjudication

Process improvements

Oncology diagnostics

AI tools familiarity

Education

Bachelor of Science in Nursing

Tools

Automation tools

AI tools

Job description

Responsibilities

Key responsibilities include independently handling high-dollar and ambiguous appeals, translating payer policies into clinical justification, coordinating with providers, mentoring team members, and driving process improvements to enhance overturn rates and revenue. The role involves analyzing denial patterns, contributing to workflow and SOP development, monitoring payer policy changes, and supporting digital transformation initiatives.

Qualifications

Active clinical licensure (RN, NP), bachelor’s degree in nursing, 3–5 years in healthcare reimbursement, prior experience with appeals and denials, and deep understanding of payer medical policies and claims adjudication. Preferred skills include oncology diagnostics experience, participation in process improvements, and familiarity with healthcare automation or AI tools.