[Hiring] Reimbursement Specialist (Claim Denial & Appeal Focus) @Castle Biosciences

Role Description

This individual is responsible for resolving denied insurance claims for laboratory services by:

• Providing payers with requested documentation
• Initiating the appeal process on behalf of the patient
• Following up on outstanding transactions
• Delivering the highest level of customer service to internal and external customers

The role spends most of its time:

• Reviewing and resolving front-end claim issues to ensure timely, accurate submission
• Reviewing Explanation of Benefits (EOBs), electronic remittance advice, and denial letters
• Assigning ANSI codes
• Taking appropriate action in the billing system
• Contacting insurance companies for missing information or claim status
• Using payer portals for follow-up
• Supplying additional documentation needed to adjudicate claims
• Creating custom appeals with appropriate arguments to overturn denials based on payer medical policy or state laws
• Submitting both standard and custom appeal letters for insurance companies including Medicare, Medicare Advantage, and commercial plans

Qualifications

• High School Diploma or equivalent GED or equivalent work experience
• Two years of health insurance billing with experience in identifying and resolving claim issues for laboratory tests
• Must have a working knowledge of various payers' designations of authorized representative forms
• Experience handling a high volume of claims work on a daily basis (35 plus claims per day)
• Must demonstrate the ability to type 35 WPM with 90% or higher accuracy

Requirements

• All candidates must be legally authorized to work in the United States
• Castle Biosciences does not sponsor H-1B visas, OPT, or employment-related visas

Benefits

• Salary Range: $46,000.00 - $47,277.00 (Final salary based on Experience and Education levels)
• Excellent Annual Salary + 20% Bonus Potential
• 20 Accrued PTO Days Annually + 10 Paid Holidays
• 401K with 100% Company Match up to 6%
• 3 Health Care Plan Options + Company HSA Contribution
• Company Stock Grant Upon Hire

Company Description

At Castle, it all comes down to people. We believe that disease management and treatment decisions can be better informed through a person's unique biology, which is revealed through the scientific rigor of our innovative, laboratory-developed tests. We are committed to empowering healthcare providers and patients with the goal of improved outcomes.

• Every employee at Castle has an impact on patient care
• We work to ensure that everyone finds their work to be both challenging and rewarding
• We behave with integrity and treat our colleagues with respect and kindness
• Our culture fosters an environment of trust, transparency, and collaboration
• We prioritize and encourage internal growth and professional development
• Castle Biosciences is an equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities