[Hiring] Senior Clinical Reimbursement Specialist @Veracyte

Role Description

We are seeking an experienced Senior Clinical Reimbursement Specialist to serve as a clinical subject matter expert on our Clinical Reimbursement Operations team. In this role, you will independently manage complex pre- and post-service appeals, mentor junior team members, and drive process improvements that measurably improve overturn rates and revenue capture across the revenue cycle.

You will apply advanced clinical judgment and deep payer policy expertise to handle the team's most complex, high-dollar, and precedent-setting cases - including Level 2 appeals, external reviews, and payer escalations. Beyond individual casework, you will contribute to workflow design, SOP development, and cross-functional initiatives that strengthen the team's overall performance.

Success in this role requires advanced knowledge of reimbursement systems (including payer utilization management and claims adjudication), fluency in payer medical policies, sound and independent clinical judgment on complex cases, and the ability to influence outcomes through both direct case ownership and informal leadership.

Qualifications

• Active clinical licensure (e.g., RN, NP).
• Associate or Bachelor's degree in nursing.
• 3–5 years of experience in healthcare reimbursement, revenue cycle operations, or payer-facing roles.
• 2+ years of experience in prior authorization, denial management, or appeals - including pre-service and post-service workflows.
• Advanced understanding of payer medical policies, prior authorization, claims adjudication, denials, and appeals - including Level 1, Level 2, and external review processes.
• Demonstrated ability to independently manage complex, ambiguous, or high-dollar cases without routine escalation.
• Proven ability to translate complex payer medical policy criteria into patient-specific clinical justification.
• Strong critical thinking and analytical skills, including the ability to interpret incomplete denial information and drive appropriate next steps without direction.
• Experience contributing to the development of SOPs, appeal letter templates, workflow tools, or other operational assets within a reimbursement environment.
• Demonstrated ability to mentor or provide informal leadership to peers, including case review, coaching, or SME support.
• Excellent communication and collaboration skills, with the ability to influence cross-functional discussions and convey clinical/reimbursement concepts to both clinical and non-clinical stakeholders.
• Demonstrates ownership of cases through resolution, including follow-up, coordination, and appropriate escalation.
• Comfortable working in an evolving environment with shifting priorities, ambiguity, and the need to build systems where none exist.

Requirements

• Prior experience in oncology diagnostics, laboratory services, or complex/specialty reimbursement environments.
• Experience leading or contributing to process improvement, workflow redesign, or operational scaling initiatives within the revenue cycle.
• Familiarity with digital transformation initiatives in healthcare operations (automation, AI/agentic workflows, workflow tools, system integration).
• Relevant certification (CPC, CRCR, CHFP, Lean/Six Sigma) or Master's degree (MSN, MHA, MBA).

Benefits

• For San Diego based candidates, the salary range is $113,276 - $125,000.
• For South San Francisco based candidates, the salary range is $119,110 - $137,657.
• For candidates in other locations in the U.S., the salary range is $86,098 - $107,850.