Reimbursement Specialist, Appeals

REIMBURSEMENT SPECIALIST, APPEALS: We are looking for an enthusiastic, detail-oriented Reimbursement Specialist, Appeals to join our RCM team and support post-claim submission activities. The Reimbursement Specialist, Appeals role is responsible for managing denials, preparing and submitting appeals with the goal to maximize reimbursement, reduce denials, and influence payer behavior. This role combines payor terminology knowledge, ability to understand denials, basic payor policy comprehension, and cross-functional collaboration to handle appeals and ensure accurate reimbursement across all lines of business. This is a full-time position based in Lake Forest, CA. At Lucid Diagnostics, we believe early detection will make esophageal cancer a disease of the past. We're using next generation sequencing to fundamentally change the way esophageal precancer is detected. Our groundbreaking EsoGuard DNA test assesses genes from cells collected from the esophagus in a quick, non-invasive procedure. This gives clinicians the ability to detect disease before it progresses to cancer, all without the need for sedation. We're focused on making a difference in patient care and we are seeking ambitious team members who do the same. When you join Lucid Diagnostics, you become part of a diverse, inclusive, and mission-driven team. We’re committed to creating an environment where you can thrive both professionally and personally. Here’s what you can expect when you join our team: Comprehensive Benefits:Enjoy top-tier medical, dental, and vision coverage, with 98% of employee healthcare premiums paid by the company, plus company-paid basic life insurance, and short- and long-term disability coverage. Financial Wellness:Build your future with acompany 401(k) match (with immediate vesting) and an Employee Stock Purchase Program (ESPP) that lets you share in our success. Rest, Recharge and Give Back:Paid vacation, sick days, 12 company holidays, and a dedicated volunteer day to give back to the causes that matter to you. Professional Growth:Take your career to the next level with ongoing learning opportunities, hands‑on training, and clear pathways for advancement. Wellbeing Support:Access employee assistance programs, wellness initiatives, and gym reimbursement to help you feel your best inside and outside of work. A Winning Culture:Proudly recognized as one of GenomeWeb’s 2025 Best Places to Work, we celebrate collaboration, innovation, and shared purpose every day. Job Responsibilities: Reporting to the Manager, Appeals and Denial Resolution, this role supports the RCM department with a focus on claims denials, underpayments, and appeals resolution. Investigate denials, prepare and submit appeals, and following up with payors to ensure timely and accurate reimbursement. Contact insurance companies and utilize payor portals to investigate denials, determine next steps, and perform appeals follow‑up. Review and interpret Explanation of Benefits (EOBs) to determine allowances and identify root causes of denials. Manage various denial types that may result in low‑pay appeals, prior authorizations, Clinical and Administration Level 1 and Level 2 appeals. Submit corrected claims and appeals in accordance with payer guidelines and timelines. Asses denied cases and prepare higher‑level appeals for compelling cases for the leadership review and submission when required. Maintain accurate documentation of denials, appeals actions, and payer communications. Assist in developing and maintaining payer‑specific appeals workflows and documentation requirements. Communicate with patients and providers regarding appeals‑related billing questions, EOBs, and financial responsibility in complex or escalated cases. Critically assess challenging situations and elevate to the Supervisor or leadership when appropriate. Prioritize multiple concurrent appeals and operate with a sense of urgency. Ensure compliance with all applicable Federal and State billing regulations, HIPAA and company policies. Job Qualifications: 4+ years of experience in reimbursement, denials management, or revenue cycle management within a diagnostics company, laboratory, or commercial payer environment. Bachelor's degree or equivalent experience. Strong understanding of medical benefit structures, including Federal, State, PPO, HMO, and indemnity plans. Working knowledge of CPT, ICD-10, and HCPCS coding, as well as LCD/NCD coverage and reimbursement guidelines. Proven ability to analyze denials, identify root causes, and resolve issues effectively. Excellent verbal and written communication skills with a customer service mindset. Strong troubleshooting, organizational, and time‑management skills. Ability to adapt to changes. Experience with Prior Authorizations preferred. Experience with a billing vendor (e.g., Xifin, Quadax, or Telcor) preferred. PAVmed and its subsidiaries are committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. We are also committed to compliance with all fair employment practices regarding citizenship and immigration status. #J-18808-Ljbffr