# Senior Clinical Reimbursement Specialist **Company**: Veracyte **Location**: Remote **Work arrangement**: remote **Experience**: senior **Job type**: full-time **Salary**: $86,098-$137,657 USD **Category**: Healthcare **Industry**: Healthcare **Apply**: https://job-boards.greenhouse.io/veracyte/jobs/5225509007?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/jobs/job_29354c11-4ce ## Description At Veracyte, we offer exciting career opportunities for those interested in joining a pioneering team that is committed to transforming cancer care for patients across the globe. We are seeking an experienced Senior Clinical Reimbursement Specialist to serve as a clinical subject matter expert on our Clinical Reimbursement Operations team. In this role, you will independently manage complex pre- and post-service appeals, mentor junior team members, and drive process improvements that measurably improve overturn rates and revenue capture across the revenue cycle. **Primary Duties and Responsibilities** - Independently manage complex pre- and post-service appeals across Level 1, Level 2, and external review pathways, including the review, development, and submission of clinically robust appeal documentation. - Serve as a clinical subject matter expert on payer medical policies, translating complex policy criteria into patient-specific clinical justification and guiding appeal strategy for high-dollar, ambiguous, or precedent-setting cases. - Own end-to-end resolution of assigned cases, including follow-up, coordination with ordering providers, and appropriate escalation to leadership when warranted. - Partner with ordering physicians and practice staff to coordinate peer-to-peer reviews, gather supplemental clinical documentation, secure Authorized Representative forms and signatures, and support collaborative initiatives that strengthen appeal outcomes. - Mentor and provide informal guidance to Clinical Reimbursement Specialists, including case review, appeal letter quality feedback, and coaching on payer policy interpretation. - Lead analysis of denial patterns and appeal outcomes to identify root causes, and drive upstream feedback to reduce future denials. - Contribute directly to the development and refinement of appeal letter templates, clinical evidence packets, payer reference guides, and other scalable operational tools. - Monitor payer behavior and policy changes across all lines of business; flag material changes and partner with leadership on remediations, coverage reviews, and payer escalations. - Support the maintenance and continuous improvement of SOPs, ensuring workflows remain consistent, compliant, and scalable as the team grows. - Serve as point of contact for complex patient- or provider-facing inquiries, ensuring accurate, empathetic, and compliant communication. - Support digital transformation initiatives, including automation and AI/agentic workflow pilots that improve appeal readiness scoring and clinical documentation review. - Represent the Clinical Reimbursement team in cross-functional initiatives and special projects that support evolving reimbursement and operational priorities. **Qualifications** - Active clinical licensure (e.g., RN, NP). - Associate or Bachelor's degree in nursing. - 3–5 years of experience in healthcare reimbursement, revenue cycle operations, or payer-facing roles. - 2+ years of experience in prior authorization, denial management, or appeals - including pre-service and post-service workflows. - Advanced understanding of payer medical policies, prior authorization, claims adjudication, denials, and appeals - including Level 1, Level 2, and external review processes. - Demonstrated ability to independently manage complex, ambiguous, or high-dollar cases without routine escalation. - Proven ability to translate complex payer medical policy criteria into patient-specific clinical justification. - Strong critical thinking and analytical skills, including the ability to interpret incomplete denial information and drive appropriate next steps without direction. - Experience contributing to the development of SOPs, appeal letter templates, workflow tools, or other operational assets within a reimbursement environment. - Demonstrated ability to mentor or provide informal leadership to peers, including case review, coaching, or SME support. - Excellent communication and collaboration skills, with the ability to influence cross-functional discussions and convey clinical/reimbursement concepts to both clinical and non-clinical stakeholders. - Demonstrates ownership of cases through resolution, including follow-up, coordination, and appropriate escalation. - Comfortable working in an evolving environment with shifting priorities, ambiguity, and the need to build systems where none exist. **Preferred** - Prior experience in oncology diagnostics, laboratory services, or complex/specialty reimbursement environments. - Experience leading or contributing to process improvement, workflow redesign, or operational scaling initiatives within the revenue cycle. - Familiarity with digital transformation initiatives in healthcare operations (automation, AI/agentic workflows, workflow tools, system integration). - Relevant certification (CPC, CRCR, CHFP, Lean/Six Sigma) or Master's degree (MSN, MHA, MBA). **What We Can Offer You** Veracyte is a growing company that offers significant career opportunities if you are curious, driven, patient-oriented and aspire to help us build a great company. We offer competitive compensation and benefits, and are committed to fostering an inclusive workforce, where diverse backgrounds are represented, engaged, and empowered to drive innovative ideas and decisions. ## Skills ### Required - clinical licensure - healthcare reimbursement - revenue cycle operations - payer medical policies - prior authorization - denial management - appeals - clinical judgment - analytical skills - communication skills - collaboration skills ### Nice to have - oncology diagnostics - laboratory services - complex/specialty reimbursement environments - process improvement - workflow redesign - operational scaling initiatives - digital transformation initiatives - automation - AI/agentic workflows - workflow tools - system integration - CPC - CRCR - CHFP - Lean/Six Sigma - Master's degree --- Source: [Apply at job-boards.greenhouse.io](https://job-boards.greenhouse.io/veracyte/jobs/5225509007?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)