Our team is growing, and we currently have an immediate opening for a Reimbursement Support Specialist-IVD Title Reimbursement Support Specialist-IVD Location Remote Reports To Director, Billing & Reimbursement Job Overview Reimbursement Support Specialist- IVD Products supports the company’s compliance with federal and state laws by preparing and distributing accurate billing and reimbursement educational materials related to in-vitro diagnostic (IVD) test kits. This role involves communicating reimbursement information to customers, assisting with provider education, and ensuring all activities align with regulatory requirements and internal policies. Essential Duties & Responsibilities - Provide timely and accurate support to customer inquiries via telephone and email.
- Share publicly available coverage determinations such as Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and commercial payer policies.
- Monitor and report status of individual Medicare Administrative Contractor (Mac) Local Coverage Determination applications.
- Develop and distribute customized appeal templates incorporating peer-reviewed publications and NCCN guideline inclusions to support medical necessity.
- Provide reporting on payer-specific LDT claim trends including denial and appeal resolution metrics.
- Ensure all billing and reimbursement content is accurate, based solely on publicly available payer information.
- Include standard disclaimers highlighting payer variations and emphasizing provider responsibility for coding and billing decisions.
- Document all client interactions, inquiries, and resolutions accurately in the CRM system.
- Promptly report any suspected violations of the company’s reimbursement policies or applicable laws to the Compliance Officer or confidential hotline.
- Participate in periodic reviews and updates of reimbursement materials to ensure continued regulatory compliance.
- Perform other duties as assigned to support team goals and operational needs.
Qualifications & Requirements - Bilingual (English/Spanish) preferred.
- Associates Degree in Business Administration or Health Information Management preferred or equivalent work experience of 3 years in Revenue Cycle Management
- Knowledge of medical billing and coding systems, including CPT, HCPCS, ICD-10, and CMS fee schedules.
- Familiarity with federal regulations affecting healthcare reimbursement, including FDA, CMS, Anti-Kickback, False Claims Act, and HIPAA rules.
- Microsoft Excel proficiency
- Solid analytical, mathematical, and research skills
- Great interpersonal skills
- Excellent communication skills (written and verbal)
- Strong attention to detail and highly organized
- Ability to handle multiple demands and to respond rapidly to changing priorities
- Commitment to ethical standards and regulatory compliance.
Work Environment / Physical Requirements: -
Ability to sit and/or stand and operate a computer with ability to multitask across many software communication and data entry programs while operating and communicating through telephone device for several hours a day. \ -
This position may require involvement outside of standard business hours ----------------------------------------------- Cleveland Diagnostics, Inc., is developing highly efficacious, lab-friendly, affordable diagnostics tests using proprietary technology to improve cancer diagnostics. We pride ourselves in fostering a family-focused, friendly, and flexible organization that places our employee’s well-being and happiness as the primary reason for our success. Are you interested in building your career with a team of industry professionals while making a lasting impact to the lives of millions of people? Bring your talents to Cleveland Diagnostics. Cleveland Diagnostics offers an extremely robust benefits package which includes: - 100% Employer-paid medical for single coverage effective on your date of hire and 50% employer-paid medical for spouse/dependent coverage
- 100% Employer-paid Dental & Vision for entire family
- No cost for employee coverage for Group Term Life, Short & Long Term Disability
- 4% retirement contribution Employer match
- Incentive Performance Plan & Stock Option Program & Commission (Sales Account Execs)
- Paid Family Leave Program
- Generous PTO plan & holiday program
- Flexible work schedule & lucrative employee referral program
- Salary range may vary by work state/geographical region/territory
- Easy to get to office location with newly built-out office space
- Free coffee, snacks and other goodies all day long
Cleveland Diagnostics is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because that is what drives curiosity, innovation, and the success of our business. EEO is the Law. Applicants can learn more about the company’s status as an equal opportunity employer by viewing the federal EEO is the Law poster on our careers page. Accommodations are available for applicants with disabilities.
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