About Us

Would you like to be part of a fast-growing team that believes no one should have to succumb to HPV-driven cancers? Naveris, a biotech startup based near Boston, MA, is looking for a Reimbursement Specialist team member to help us develop our next great product for patients at risk of developing viral cancers. Our flagship test, NavDx, is a breakthrough blood-based DNA test for HPV cancers, clinically proven and already trusted by hundreds of physicians and institutions across the U.S.

Opportunity

We are looking for a conscientious, knowledgeable individual to join our team, and be responsible for handling the varied aspects of the reimbursement process. We use an outsourced RCM vendor, but need additional oversight which may include focusing onaccurate claims submissions and appeals submissionsfrom all payers including Medicare, Medicaid, and commercial insurance plans.

Job Responsibilities

Reporting to the Manager Reimbursement and Appeals, you will be supporting the Reimbursement department. This position is remote. Duties may include:

Maximize reimbursement payments by reviewing eligibility, claim submissions for accuracy
Maximize payment reimbursements by reviewing appeals submissions for accuracy
Be persuasive and persistent when following up on claims and appeal status
Identify correct appeals pathways for various health plans
Investigate denied services to determine reason and appeal. Identify and report root causes associated with denials
Process assigned appeals correctly
Ability to talk to patients and explain insurance related processes, clarify EOB, or address any other related non-clinical issues
Maximize utilization of systems, tools, and resources to support reimbursement activities
Process and validate payor requests and claims via correspondence, remittance advice and EOBs (i.e., identify payment discrepancies, inappropriate requests)
Comply with Federal and State legislation on all billing related matters

Qualifications

Minimum of 4+ years specializing in reimbursement/revenue cycle management at a diagnostics company or laboratory or working for a commercial payer
College degree or 4 years of equivalent experience
Experience with Xifin, Quadax, or Telcor preferred
Must possess detailed knowledge of all medical benefit levels and have a thorough understanding of Federal, State, PPO, HMO, andIndemnity Plans structures
Working knowledge of appropriate coding systems; CPT, ICD-9 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes
Strong problem-solving skills with ability to streamline and improve processes, use good judgment, attention to detail and follow-through are a must
Excellent customer service skills; excellent verbal and written communication skills
Excellent troubleshooting and time management skills, attention to detail, utilizes time in constructive manner
Ability to easily adapt to increased business demands
Self-starter, ability to work independently

Compliance Responsibilities

Health Insurance Portability and Accountability Act (HIPAA) is a federal law that describes the national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. All roles at Naveris require compliance with legal and regulatory requirements of HIPAA and acceptance and adherence to all policies and standards at Naveris. Personnel acknowledges they are personally responsible for reporting any suspected violations or abuse and are required to complete HIPAA training when joining the company.

Why Naveris?

In addition to our great team and advanced medical technology, we offer our employees competitive compensation, work/life balance, remote work opportunities, and more!

Naveris is an Equal Opportunity Employer

Naveris is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We don’t just accept differences - we celebrate and support them. We do not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

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Reimbursement Specialist