Reimbursement Specialist

Do you want to join one of the fastest-growing molecular diagnostics companies to help transform prenatal and oncology diagnostics that can affect millions of patient lives?

BillionToOne (Y Combinator S17), ranked at the top 5% of Y Combinator companies with $200M+ in funding from prominent VC firms, has developed the first and only non-invasive prenatal screen that directly assesses a baby's risk for common and severe disorders such as cystic fibrosis, spinal muscular atrophy (SMA), and down's syndrome from a single tube of blood from the pregnant mother.

We are looking for a Reimbursement Specialist to be responsible for focusing on collections and appeals from various Federal, State, & Third Party (HMO, PPO, IPA, TPA Indemnity) payers. The ideal candidate must be able to (1) Maximize payment reimbursements by reviewing accounts for billing accuracy, (2) Be persuasive and persistent when following up on claims status, and (3) process an appeal, re-bill, or forward claims for recalculation and/or adjudication as necessary. The Reimbursement Specialist is a remote position and will report to the Director of Reimbursement.

Responsibilities:

• Correct insurance assignments on patient accounts, and verify insurance eligibility.
• Review/update patient demographics and information for accuracy.
• Process and validate payer requests and claims via correspondence, remittance advice and EOBs (i.e., identify payment discrepancies, inappropriate requests)
• Investigate all denied services to determine the denial reason, appeal, if appropriate. Identify, report root causes associated with denials
• Process assigned appeals including development, submission, tracking, reporting and evaluation of appeal outcomes (i.e., next steps, improved outcomes)
• Maximize utilization of Billing system, tools and resources to support cash collection activities
• Review various reports including aging, adjustments and credit balances.
• Comply with Federal and State legislation on all billing related matters.
• Comply with all Safety, Emergency, Hazard, OSHA, HIPAA, Quality Assurance and Administrative Plans, Policies, Guidelines, Protocol, and Standards.
• Support and maintain department cash and DSO goals.

Qualifications:

• 4+ years specializing in Medical Collections at a medical corporation, diagnostics company, or lab, doing collections from commercial payers.
• Must possess detailed knowledge of all medical benefit levels and have a thorough understanding of Federal, State, & PPO, HMO, and Indemnity Plans structures.
• Hands-on experience managing the entire appeals process
• Working knowledge of appropriate coding systems; CPT, ICD-9 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes.
• High School Diploma or a Bachelor's degree from a four-year college or university
• Strong problem solving skills with ability to streamline and improve processes, use good judgment, attention to detail and follow-through are a must.
• Excellent customer service skills; excellent verbal and written communication skills
• Excellent troubleshooting and time management skills, attention to detail, utilizes time in constructive manner
• Ability to easily adapt to increased business demands
• Ability to effectively work with and resolve complex accounts & billing issues
• Self-starter, ability to work independently
• Ability to effectively prioritize and multi-task
• Ability to work in fast paced environment, perform under pressure, meet tight timelines
• Establish and maintain cohesive and good working relationships

BillionToOne is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.