About the Opportunity:

We are seeking a dedicated RCM Appeals Specialist to join a pioneering team focused on revolutionizing cancer diagnostics, particularly in the realm of brain and spinal cord tumors. This dynamic role offers a unique chance to influence patient care by ensuring accurate reimbursement for advanced laboratory tests. If you are passionate about healthcare innovation and thrive in a fast-paced, mission-driven environment, this is the role for you.

Location: Chicago, IL (Hybrid - 4 days in-office per week)

Key Responsibilities:

• Appeals and Denial Management: Navigate and resolve insurance denials, ensuring compliance with medical necessity standards and payer policies. Prepare and track multi-level appeals, engaging external resources as necessary.
• Clinical and Coding Collaboration: Work closely with clinical and revenue cycle teams to gather and present comprehensive clinical documentation. Interpret laboratory reports and align them with payer coverage policies.
• Payer Policy and Regulatory Expertise: Stay informed on Medicare, Medicaid, and commercial payer policies. Analyze coverage determinations to support robust appeal arguments.
• Tracking, Reporting, and Compliance: Maintain detailed records of appeal activities and outcomes. Ensure readiness for audits and compliance with HIPAA regulations.

Qualifications:

• Bachelor’s degree in Health Information Management, Healthcare Administration, Life Sciences, or a related field.
• 3-5 years of experience in medical billing, insurance appeals, or revenue cycle management, with a focus on laboratory billing.
• Professional certifications such as CPB, CRCS, CCS, or CPC are required.

Preferred Qualifications:

• Experience in a clinical or commercial laboratory setting.
• Familiarity with MolDX program requirements and major commercial payer policies.
• Proficiency with payer portal tools such as Availity.

Skills and Abilities:

• Strong understanding of molecular diagnostic testing workflows and terminology.
• Excellent written communication skills to craft compelling appeal letters.
• Advanced analytical abilities to interpret payer policies and denial rationales.
• Highly organized and detail-oriented, with the ability to manage multiple priorities and deadlines effectively.

This is an exciting opportunity for career growth and advancement in the ever-evolving field of cancer diagnostics. Applicants must be legally authorized to work in the U.S.