Insurance Authorization Specialist

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 Insurance Authorization Specialist is to complete authorizations with insurance companies. Authorizations will be submitted via payer portals, fax and vendors. The Specialist will be expected to follow-up on submissions to ensure timely completion, and appeal denied authorizations. Because CareDx patients receive multiple tests, authorizations may be obtained and documented for future testing, or as test orders are received.  

This role requires meticulous, timely work and the ability to thrive in a fast-paced team 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: 

1. Authorization submissions:
   • Prioritize an assigned work queue to ensure timely work is balanced with working the most payable accounts.
   • Create an authorization request that may include patient medical records to justify medical necessity for CareDx testing.
   • Work with teammates to obtain any missing medical records.
   • Determine the ideal method, documentation and pathway for authorization submission based on the patient’s insurance.
   • Use payer websites, or portals, laboratory benefit manager (LBM) portals, or fax to submit the authorization requests.
   • Follow up on authorization submissions to ensure timely completion 
2. Authorization appeals:
   • When authorization requests are denied, submit appeals to challenge payer decisions.
   • Identify approval and denial trends and share best practices. Escalate denial trends to CareDx Revenue Cycle Management leaders, Market Access and/or Payer Dispute Resolution.
   • Propose solutions and collaborate cross-functionally with the Denials Management Steering Committee.
   • Share opportunities to improve upstream work to prevent denials.
   • Work with patients when their assistance is needed in the appeal process.
   • Work professionally with Revenue Cycle teammates to be responsive to requests that require your assistance.

Qualifications: 

• High school diploma or equivalent.
• 3-5 years’ experience in data entry, authorizations or medical billing; strong preference will be given to candidates with molecular laboratory billing experience. Authorization or medical billing experience may be substituted with a bachelor’s degree.
• 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.

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.

For HR administration purposes, the job title is Reimbursement Associate I.

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