CareDx, Inc. is a leading precision medicine solutions company focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients and caregivers. CareDx offers products, testing services, and digital healthcare solutions along the pre- and post-transplant patient journey, and is the leading provider of genomics-based information for transplant patients.
The primary responsibility of the Payer Submission Specialist is to maximize reimbursement by compiling and submitting packets of appeals and medical records to insurance companies via payer portals, fax, and mail. The Specialist will assist in following up on submissions to ensure receipt. The Specialist will work with the CareDx Payer Dispute Resolution and Market Access teams to ensure CareDx receives broad coverage and appropriate reimbursement from contracted and non-contracted payers and government health plans.
This role requires meticulous work and the ability to thrive in a fast-paced, high volume environment. This is a full-time position, Monday through Friday, with occasional overtime as needed. Candidates within commuting distance of the Brisbane, California office will need to come to the office on a regular basis; remote candidates will work and collaborate from home.
Responsibilities:
Medical record and appeal packet submission:
Find relevant patient records in CareDx system and attach a cover letter or appeal letter.
Log in to a payer portal and accurately fulfill medical record requests or submit an appeal using the completed packet and completing any required portal information.
Work with patients when their assistance is needed in the appeal process, including obtaining appointments of representative (AORs) from patients.
Work professionally with Revenue Cycle teammates to be responsive to requests that require your assistance.
Medical Record and Appeal Follow-up:
Resolve aged medical record and appeal submissions without payer responses via payer portals & outbound phone calls.
Assist teammates with projects and denial work queue management.
Qualifications:
High school diploma or equivalent.
6-12 months' experience in medical billing or medical records.
Typing speed of at least 50 words per minute.
Understanding of patient protections under HIPAA and proper handling of protected health information (PHI).
Working knowledge of health insurance and terminology.
Excellent communication and people skills.
Meticulous with strong analytical and problem-solving abilities in a high volume production environment.
Additional Details:
Every individual at CareDx has a direct impact on our collective mission to improve the lives of organ transplant patients worldwide. We believe in taking great care of our people, so they take even greater care of our patients.
Our competitive Total Rewards package includes:
Competitive base salary and incentive compensation
Health and welfare benefits including a gym reimbursement program
401(k) savings plan match
Employee Stock Purchase Plan
Pre-tax commuter benefits
And more!
In addition, we have a Living Donor Employee Recovery Policy that allows up to 30 days of paid leave annually to a full-time employee who makes the selfless act of donating an organ or bone marrow.
With products that are making a difference in the lives of transplant patients today and a promising pipeline for the future, it's an exciting time to be part of the CareDx team. Join us in partnering with transplant patients to transform our future together.
CareDx, Inc. is an Equal Opportunity Employer and participates in the E-Verify program.
By proceeding with our application and submitting your information, you acknowledge that you have read our U.S. Personnel Privacy Notice and consent to receive email communication from CareDx.
******** We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.
#LI-Remote
CareDx, Inc. is an Equal Opportunity Employer and participate in E-Verify program.
