Reimbursement, Reimbursement Specialist (Claim Denial & Appeal Focus)

About the role

This individual is responsible for resolving denied insurance claims for laboratory services by providing payers with requested documentation, initiating the appeal process on behalf of the patient, following up on outstanding transactions, and delivering the highest level of customer service to internal and external customers. The role spends most of its time reviewing and resolving front-end claim issues to ensure timely, accurate submission; reviewing Explanation of Benefits (EOBs), electronic remittance advice, and denial letters; assigning ANSI codes; and taking appropriate action in the billing system. Responsibilities include contacting insurance companies for missing information or claim status, using payer portals for follow-up, and supplying additional documentation needed to adjudicate claims. The role also involves creating custom appeals with appropriate arguments to overturn denials based on payer medical policy or state laws and submitting both standard and custom appeal letters for insurance companies including Medicare, Medicare Advantage, and commercial plans.

Responsibilities

• Review and resolve front-end claim issues to ensure timely, accurate submission
• Review Explanation of Benefits (EOBs), electronic remittance advice, and denial letters
• Assign ANSI codes and take appropriate action in the billing system
• Contact insurance companies for missing information or claim status
• Use payer portals for follow-up and supply additional documentation needed to adjudicate claims
• Create custom appeals with appropriate arguments to overturn denials based on payer medical policy or state laws
• Submit standard and custom appeal letters for Medicare, Medicare Advantage, and commercial plans

Requirements

• High School Diploma or equivalent GED or equivalent work experience
• Two years of health insurance billing with experience in identifying and resolving claim issues for laboratory tests
• Working knowledge of various payers' designations of authorized representative forms
• Experience handling a high volume of claims work on a daily basis (35+ claims per day)
• Ability to type 35 WPM with 90% or higher accuracy
• Legally authorized to work in the United States; Castle Biosciences does not sponsor H-1B visas, OPT, or employment-related visas

Benefits

• Exceptional Benefits Package
• 20 Accrued PTO Days Annually + 10 Paid Holidays
• 401K with 100% Company Match up to 6%
• 3 Health Care Plan Options + Company HSA Contribution
• Company Stock Grant Upon Hire

Pay

Salary Range: $46,000.00 - $47,277.00 (final salary based on Experience and Education). Excellent Annual Salary + 20% Bonus Potential.

Schedule

Monday - Friday, 8:00 AM to 5:00 PM, non-exempt position, working remotely from your home office based in the USA.