Reimbursement Specialist

About Us

Would you like to be part of a fast-growing team that believes no one should have to succumb to cancer? Naveris, a commercial stage precision oncology company based near Boston, MA, is looking for a Reimbursement Specialist to help us deliver on our Mission to develop novel diagnostics that transform cancer detection and improve patient outcomes. Our flagship test, NavDx, is a breakthrough blood-based DNA test for HPV-induced cancers, clinically proven and already trusted by tens of thousands of patients and physicians across the U.S.

Opportunity

We are looking for a conscientious, knowledgeable individual to join our team, and be responsible for handling the varied aspects of the reimbursement process. We use an outsourced RCM vendor, but need additional oversight which may include focusing on accurate claims submissions and appeals submissions from all payers including Medicare, Medicaid, and commercial insurance plans.

Reporting to the Manager Reimbursement and Appeals , you will be supporting the Reimbursement department. This position is remote. Duties may include:

• Maximize reimbursement payments by reviewing eligibility, claim submissions for accuracy.
• Maximize payment reimbursements by reviewing appeals submissions for accuracy.
• Be persuasive and persistent when following up on claims and appeal status.
• Identify correct appeals pathways for various health plans.
• Investigate denied services to determine reason and appeal. Identify and report root causes associated with denials.
• Process assigned appeals correctly.
• Ability to talk to patients and explain insurance related processes, clarify EOB, or address any other related non-clinical issues.
• Maximize utilization of systems, tools, and resources to support reimbursement activities.
• Process and validate payor requests and claims via correspondence, remittance advice and EOBs (i.e., identify payment discrepancies, inappropriate requests)
• Comply with Federal and State legislation on all billing related matters.

Qualifications

• Minimum of 4+ years specializing in reimbursement/revenue cycle management at a diagnostics company or laboratory or working for a commercial payer.
• College degree or 4 years of equivalent experience.
• Experience with Xifin, Quadax, or Telcor preferred.
• Must possess detailed knowledge of all medical benefit levels and have a thorough understanding of Federal, State, PPO, HMO, and Indemnity Plans structures.
• Working knowledge of appropriate coding systems; CPT, ICD-9 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes.
• 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.
• Self-starter, ability to work independently.

Compliance Responsibilities

Health Insurance Portability and Accountability Act (HIPAA) is a federal law that describes the national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. All roles at Naveris require compliance with legal and regulatory requirements of HIPAA and acceptance and adherence to all policies and standards at Naveris. Personnel acknowledges they are personally responsible for reporting any suspected violations or abuse and are required to complete HIPAA training when joining the company.

Why Naveris?

In addition to our great team and advanced medical technology, we offer our employees competitive compensation, work/life balance, remote work opportunities, and more!

Naveris is an Equal Opportunity Employer

Naveris is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We don’t just accept differences - we celebrate and support them. We do not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.