Senior Clinical Reimbursement Specialist

Veracyte seeks an experienced Senior Clinical Reimbursement Specialist to manage complex appeals, mentor junior staff, and drive process improvements across the clinical reimbursement operations team. This remote position requires advanced clinical judgment and payer policy expertise to handle high-stakes cases and strengthen revenue cycle performance.

Responsibilities

• Independently manage complex pre- and post-service appeals at Level 1, Level 2, and external review stages
• Develop clinically robust appeal documentation and strategy for high-dollar or precedent-setting cases
• Mentor Clinical Reimbursement Specialists on case review, policy interpretation, and appeal quality
• Coordinate with physicians and staff on peer-to-peer reviews and clinical documentation gathering
• Analyze denial patterns and drive upstream feedback to reduce future denials

Requirements

• Advanced knowledge of reimbursement systems, payer utilization management, and claims adjudication
• Deep expertise in payer medical policies and ability to interpret complex policy criteria
• Sound clinical judgment to independently evaluate and resolve complex cases
• Experience managing multi-level appeals, external reviews, and payer escalations
• Demonstrated ability to mentor staff and influence outcomes through leadership
• Strong documentation and communication skills for appeal submissions and peer-to-peer coordination