Reimbursement Specialist - Insurance Verification

Naveris Inc.

Job Overview

Location

Waltham

Job Type

Full-time

Full Job Description

📋 Description

• Drive the front-end of revenue cycle excellence at Naveris, a high-growth precision oncology company whose flagship blood test, NavDx, is already changing the way HPV-driven cancers are detected and treated nationwide. You will be the first line of defense against delayed or denied reimbursement, ensuring every patient who trusts NavDx receives the full benefit of their insurance coverage.
• Own end-to-end insurance verification for thousands of orders per month spanning Medicare, Medicaid, and every major commercial payer. Using payer portals, clearinghouse tools, and direct phone outreach, you will confirm eligibility, benefit tiers, prior-authorization requirements, and cost-share obligations within 24 hours of order receipt.
• Translate complex payer policy language into plain-English summaries for patients and providers. When a plan denies coverage for a medically necessary test, you will escalate with concise documentation and cite the exact LCD/NCD or payer policy clause that supports payment.
• Build and maintain ultra-clean patient demographic and insurance records in Xifin (preferred) or comparable LIS/RCM platforms. Your data integrity standards will directly reduce claim rejections and accelerate cash collections.
• Proactively mine missing medical records, referring physician notes, or pathology reports required by priority payers. You will partner with Client Services and Laboratory Operations to close documentation gaps before specimens reach the lab bench.
• Serve as the go-to subject-matter expert for CPT, ICD-10, and HCPCS coding as they relate to HPV-related head & neck and cervical cancers. You will flag any order that lacks a payable diagnosis and collaborate with providers to secure compliant coding.
• Monitor payer bulletins, LCD/NCD updates, and state Medicaid changes weekly; summarize impacts in a one-page brief for the Reimbursement Supervisor and recommend workflow tweaks within 48 hours of policy release.
• Run daily exception reports to identify stalled verifications, aged prior auths, or eligibility mismatches. You will own root-cause analysis and propose fixes that cut front-end denials by double-digit percentages quarter over quarter.
• Field patient phone calls and secure-message inquiries regarding EOBs, deductible balances, and financial-assistance options. Your empathetic, jargon-free explanations will turn anxious callers into informed, loyal advocates for Naveris.
• Document every payer interaction in Salesforce or the internal CRM within the same business day, creating an auditable trail that satisfies both HIPAA and corporate compliance standards.
• Participate in monthly cross-functional “denial-prevention” huddles with Laboratory, Sales, and Medical Affairs to share front-end insights that shape test-ordering protocols and payer policy advocacy.
• Travel up to 5 % annually to Waltham HQ or payer training centers for deep-dive sessions on new billing rules or platform upgrades; all other work is performed remotely from any U.S. location with secure internet access.
• Champion a culture of continuous improvement by piloting new verification tools, macros, or AI-enabled eligibility bots—then measuring their impact on turnaround time and accuracy.
• Uphold strict HIPAA compliance in every action, completing annual training and immediately reporting any suspected privacy or security incident to the Compliance Officer.

🎯 Requirements

• 2+ years of high-volume insurance verification or prior-authorization experience in a laboratory, hospital, or specialty-diagnostics setting
• Demonstrated fluency with Medicare LCDs/NCDs and major commercial payer medical policies
• Hands-on proficiency with Xifin, Epic, Cerner, or comparable LIS/RCM systems
• Ability to interpret and apply CPT, ICD-10, and HCPCS codes to oncology diagnostics
• Excellent written and verbal communication skills for patient and provider education

🏖️ Benefits

• Fully remote work environment with flexible scheduling
• Competitive compensation and performance-based bonus
• Comprehensive health, dental, vision, and life insurance from day one
• 401(k) with company match and immediate vesting
• Annual professional-development stipend for certifications and conferences

Skills & Technologies

Remote

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Naveris Inc.

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About Naveris Inc.

Naveris is a molecular diagnostics company focused on oncology. It develops and commercializes blood-based tests that detect tumor-specific DNA alterations to monitor minimal residual disease and recurrence in patients with solid tumors. The company’s flagship product, NavDx, is a next-generation sequencing assay that identifies and tracks circulating tumor DNA in the plasma of individuals with HPV-driven head and neck cancers. By providing clinicians with real-time genomic insights, Naveris aims to improve treatment decisions, reduce overtreatment, and enhance long-term outcomes for cancer patients. The company operates a CLIA-certified laboratory and collaborates with academic medical centers nationwide.

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