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Reimbursement Specialist

GenomeDx Biosciences is a dynamic entrepreneurial startup molecular diagnostics company focused on cancer genomics. Whether on the phone with patients, or in the cloud with big data, our innovators are working hard to give back to the patient what cancer takes away: information for life.

Our team is constantly learning from each other, from patients and from urologic oncology professionals in world-renowned cancer institutions. We work in multi-disciplinary, collaborative project teams that enable us to respond effectively to an evolving, growing, data-driven environment.

We are currently seeking for a dynamic Reimbursement Specialist with a deep understanding of reimbursement to join our team in San Diego.

GDx Innovator Profile 

The successful candidate will excel at identifying, analyzing and resolving insurance company denials. While working with our Reimbursement, Commercial and Finance teams this role will provide on-going insight and analytics on all medical insurance claims.

If you think you have what it takes to be part of an elite group of entrepreneurial innovators we invite you to consider joining the GenomeDx team.

What you are great at doing: 

  • Verifying insurance/recipient eligibility, billing and follow-up on claims to Medicare, Medicaid and Private Insurer Payers.
  • Researching and responding to Medicare, Medicaid and other Payer inquiries regarding billing issues and insurance updates.
  • Reviewing unpaid and/or denied claims, appeals and follow-up on accounts to zero status.
  • Organizing and distributing comprehensive appeal packages to the insurance provider.
  • Reviewing and interpreting explanation of benefits to determine contractual allowance.
  • Researching accounts and resolving deficiencies.
  • Calling insurance companies regarding outstanding accounts and utilizing payor websites to check claim status.
  • Reviewing and submitting accurate claims, resubmissions and claim review forms.
  • Researching and monitoring specific billing issues, trends and potential risks based on current research and customer feedback.
  • Answering all patient/doctor/hospital/lab/insurance company phone calls regarding accounts, and taking appropriate action.
  • When requested, providing administrative support for department(s) including but not limited to performing data entry, updating various record keeping systems, upholding company policies and Client requirements, and participating in projects, duties, and other administrative tasks.

What you need to be successful: 

  • A university degree or 2-year degree from an Accredited Medical Billing School
  • 3-5 Years of direct appeals and billing experience
  • Independent Certified Professional Coder (CPC) required
  • Familiarity with ICD and HCPC/CPT coding 
  • Familiarity with CMS 1500 claim form 
  • Familiarity with Claim Adjustment Reason Codes (NUCC)

What you will bring to the team: 

  • Ability to create and maintain spreadsheets
  • Ability to use analytical, interpersonal, communication, organizational, numerical, and time management skills.
  • Experience handling and expediting escalated issues, with follow up to the customer.
  • Ability to quickly assess a situation and take appropriate actions to address customer needs and requests in a timely and efficient manner. Self-starter with the ability to work independently and effectively in a team environment.
  • Ability to organize and prioritize multiple projects/tasks and meet deadlines in a constantly evolving and fast-paced environment.
  • Strong, consistent work ethic with a keen attention to details and ability to focus on the big picture.
  • Excellent written and verbal communication skills.
  • Must be able to communicate with confidence and tact across all levels within the company.
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