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Senior Clinical Reimbursement Specialist
Veracyte, Inc.Senior reimbursement specialist managing complex appeals for Veracyte, a cancer diagnostics company. Improving payer outcomes, revenue capture, workflows, and clinical documentation processes.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complex healthcare appeals and reimbursement processes, with a strong focus on payer medical policies and clinical documentation. Capable of mentoring peers and driving process improvements while maintaining compliance and effective communication.
Highest-signal resume keywords
Active Clinical LicensureHealthcare Reimbursement ExperiencePayer Medical Policy ExpertiseDenial ManagementSOP Development
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical DocumentationAppeal Strategy DevelopmentPrior AuthorizationClaims AdjudicationAnalytical SkillsWorkflow Tools DevelopmentOperational Asset CreationPatient-Specific Clinical JustificationComplex Case ManagementDenial Pattern Analysis
Soft Skills
Critical ThinkingCommunication SkillsCollaboration SkillsMentoringAdaptability
Tools & Technologies
Automation ToolsAI Workflow SolutionsOperational Tools
Industry Keywords
Revenue Cycle OperationsOncology DiagnosticsLaboratory ServicesSpecialty ReimbursementProcess Improvement
About the role
Key responsibilities & impact- Independently manage complex pre- and post-service appeals across Level 1, Level 2, and external review pathways
- Review, develop, and submit clinically robust appeal documentation
- Serve as a clinical subject matter expert on payer medical policies and guide appeal strategy for complex cases
- Own end-to-end resolution of assigned cases, including follow-up, provider coordination, and escalation
- Coordinate peer-to-peer reviews and gather supplemental clinical documentation and Authorized Representative forms and signatures
- Mentor and provide informal guidance to Clinical Reimbursement Specialists
- Analyze denial patterns and appeal outcomes, identify root causes, and drive feedback to reduce future denials
- Develop and refine appeal letter templates, clinical evidence packets, payer reference guides, and operational tools
- Monitor payer behavior and policy changes and partner with leadership on remediations, coverage reviews, and payer escalations
- Maintain and improve SOPs for consistent, compliant, and scalable workflows
- Handle complex patient- or provider-facing inquiries
- Support automation and AI/agentic workflow pilots
- Represent the Clinical Reimbursement team in cross-functional initiatives and special projects
Requirements
What you’ll need- 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
- Ability to independently manage complex, ambiguous, or high-dollar cases
- Ability to translate payer medical policy criteria into patient-specific clinical justification
- Strong critical thinking and analytical skills
- Experience developing SOPs, appeal letter templates, workflow tools, or operational assets
- Ability to mentor or provide informal leadership to peers
- Excellent communication and collaboration skills
- Ability to own cases through resolution and work effectively amid shifting priorities and ambiguity
- Preferred: experience in oncology diagnostics, laboratory services, specialty reimbursement, process improvement, workflow redesign, healthcare automation/AI, or relevant certification/master's degree
Benefits
Comp & perks- Competitive compensation and benefits
- Potential eligibility for additional discretionary bonuses/incentives
- Potential eligibility for restricted stock units
- Career opportunities and opportunities to learn and grow
- Inclusive workforce and workplace
- Recognition as a 2024 Certified Great Place to Work in the US and Israel