Remote opportunity at
VeracyteSenior Clinical Reimbursement Specialist
Veracyte is looking for a Senior Clinical Reimbursement Specialist to join its team as a clinical subject matter expert on the Clinical Reimbursement Operations group. This…
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About This Role
Veracyte is looking for a Senior Clinical Reimbursement Specialist to join its team as a clinical subject matter expert on the Clinical Reimbursement Operations group. This position functions as an independent handler of complex pre-service and post-service appeals, including Level 2 appeals, external reviews, and payer escalations. The professional filling this role will mentor junior team members and spearhead initiatives that improve overturn rates and revenue capture. Veracyte operates as…
Job Description
Veracyte is looking for a Senior Clinical Reimbursement Specialist to join its team as a clinical subject matter expert on the Clinical Reimbursement Operations group. This position functions as an independent handler of complex pre-service and post-service appeals, including Level 2 appeals, external reviews, and payer escalations. The professional filling this role will mentor junior team members and spearhead initiatives that improve overturn rates and revenue capture.
Veracyte operates as a global diagnostics enterprise dedicated to advancing cancer care worldwide by supplying clinicians with critical insights for patient decisions. This organization relies on a platform that combines genomic data, bioinformatics, artificial intelligence, and evidence generation. Qualified candidates will contribute to workflow design, standard operating procedures, and cross-functional projects while interpreting payer medical policies.
This is a full-time, remote position offering a salary range of USD 86,098 to 137,657 per year, depending on factors such as geographic location, education, and years of experience. Total compensation may also include discretionary bonuses, incentives, and restricted stock units.
Responsibilities
- Manage pre-service and post-service appeals across Level 1, Level 2, and external review pathways independently
- Serve as a clinical subject matter expert regarding payer medical policies and guide appeal strategies for high-dollar cases
- Oversee the complete resolution of assigned cases, coordinating with ordering providers and escalating to leadership when necessary
- Collaborate with medical practices to gather clinical documentation, secure signatures, and coordinate peer-to-peer reviews
- Provide mentorship and guidance to Clinical Reimbursement Specialists regarding case reviews and feedback on appeal letters
- Analyze denial trends to determine root causes and implement upstream solutions to prevent future denials
- Contribute to the creation of appeal letter templates, payer reference guides, and clinical evidence packets
- Track modifications in payer behavior and collaborate with leadership on remediations and coverage reviews
- Maintain and update standard operating procedures to keep workflows compliant and scalable
- Act as a point of contact for complex inquiries from patients and providers
- Aid in digital transformation projects involving automation and AI-driven workflow pilots
- Represent the reimbursement team during cross-functional operations and special projects
Requirements
- Active clinical licensure such as an RN or NP
- Associate or Bachelor degree in nursing
- Three to five years of professional experience in revenue cycle operations, healthcare reimbursement, or roles interfacing with payers
- At least two years of experience handling prior authorization, appeals, and denial management for both pre-service and post-service workflows
- Advanced familiarity with claims adjudication, prior authorization, payer medical policies, and external review processes
- Demonstrated ability to independently navigate complex and high-dollar cases without routine escalation
- Skill in translating intricate payer criteria into specific patient clinical justifications
- Critical thinking and analytical abilities to interpret incomplete denial documentation
- Prior involvement in drafting standard operating procedures, appeal templates, or workflow assets
- Experience providing mentorship or informal leadership to peers
Qualifications
- Prior background in oncology diagnostics, specialty reimbursement, or laboratory services
- Experience driving process improvements or scaling operations within revenue cycles
- Familiarity with digital transformation tools including automation and artificial intelligence workflows
- Relevant certifications such as CPC, CRCR, CHFP, or Lean/Six Sigma
- Master degree such as an MSN, MHA, or MBA
Core Skills
Benefits
- Discretionary bonuses or incentives
- Restricted stock units
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, the posting lists the role as remote.
What is the salary range for this job?
The salary ranges from USD 86,098 to 137,657 per year, with the exact amount dependent on geographic location, years of experience, skillset, and education.
What level of education is required for applicants?
Applicants must hold an Associate or Bachelor degree in nursing, along with an active clinical licensure like an RN or NP.
What employment type is this role?
This is a full-time position.
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