Supervisor, RCM Appeal Submissions

CareDx, Inc. is a leading precision medicine solutions company focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients and caregivers. CareDx offers products, testing services, and digital healthcare solutions along the pre- and post-transplant patient journey, and is the leading provider of genomics-based information for transplant patients.

The primary responsibility of the Supervisor, RCM Appeal Submissions is to manage a team of specialists is to maximize reimbursement by compiling and submitting packets of appeals and medical records to insurance companies via payer portals, fax, and mail.

Supervisors in the Revenue Cycle Management Denials & Appeals team will report to the Manager of their function. Team sizes may vary but are intended to be no greater than 8 full-time employees on a team; teams with more than four employees may have a team lead reporting to the supervisor. This is a full-time position, Monday through Friday, with occasional overtime as needed. Candidates within commuting distance of the Brisbane, California office will need to come to the office on a regular basis; remote candidates will work and collaborate from home.

Responsibilities:

• Leadership & Training:
  • Lead your team by establishing and documenting best practices, setting goals, training and coaching staff, and ensuring best practices are followed.
  • You will be the primary trainer on your team, with support from a team lead, if your team size allows for a team lead.
  • Weekly 1:1s with each member of your team are required, as are weekly team meetings.
  • Encourage teamwork and build camaraderie within your team through effective listening and facilitation.
  • Model professionalism and build relationships in your internal and external interactions.
  • Ensure timely, complete work by your team to minimize DSO.
• Productivity and Quality Work:
  • Manage staff productivity as a leading indicator of goal attainment.
  • Establish and implement prioritization methods for staff in work queues.
  • You will be expected to audit your team's work monthly using a scoring system and provide feedback to them.
  • Use experience and expertise to improve upon existing processes, technology and system configurations.
• Medical record and appeal packet submission:
  • Find relevant patient records in CareDx system and attach a cover letter or appeal letter.
  • Log in to a payer portal and accurately fulfill medical record requests or submit an appeal using the completed packet and completing any required portal information.
  • Work with patients when their assistance is needed in the appeal process, including obtaining appointments of representative (AORs) from patients.
  • Work professionally with Revenue Cycle teammates to be responsive to requests that require your assistance.
• Medical Record and Appeal Follow-up:
  • Resolve aged medical record and appeal submissions without payer responses via payer portals & outbound phone calls.
  • Assist teammates with projects and denial work queue management.
• Claim Follow-up:
  • Resolve aged claims and appeals without payer responses via payer portals & outbound phone calls.
  • Identify claims that need a first, second, or third level appeal.
  • Assist teammates with projects and denial work queue management.
• Denials and appeals:
  • Prioritize an assigned work queue to ensure timely work is balanced with working the most payable claims.
  • Identify non-payment trends and, in collaboration with Revenue Cycle leadership, escalate groups of claims to the CareDx Payer Dispute Resolution or Market Access teams.
  • Investigate denial and non-payment trends identified by the Revenue Cycle Analytics team. Propose solutions and collaborate cross-functionally with the Denials Management Steering Committee.
  • Share opportunities to improve upstream work to prevent denials.

Qualifications:

• High school diploma or equivalent.
• Minimum of 4 years of experience in a medical billing or authorization role. Prior experience in a supervisory role is preferred.
• Understanding of patient protections under HIPAA and proper handling of protected health information (PHI).
• Working knowledge of insurance policies, billing procedures, and claim terminology.
• Excellent communication and people skills.
• Detail-oriented with strong analytical and problem-solving abilities.
• Preference will be given to qualified candidates with experience with laboratory billing software, including Telcor, Xifin or Quadax.

Additional Details:

Every individual at CareDx has a direct impact on our collective mission to improve the lives of organ transplant patients worldwide. We believe in taking great care of our people, so they take even greater care of our patients. Our competitive Total Rewards package includes:

• Competitive base salary and incentive compensation
• Health and welfare benefits including a gym reimbursement program
• 401(k) savings plan match
• Employee Stock Purchase Plan
• Pre-tax commuter benefits
• And more!

In addition, we have a Living Donor Employee Recovery Policy that allows up to 30 days of paid leave annually to a full-time employee who makes the selfless act of donating an organ or bone marrow.

With products that are making a difference in the lives of transplant patients today and a promising pipeline for the future, it's an exciting time to be part of the CareDx team. Join us in partnering with transplant patients to transform our future together.

CareDx, Inc. is an Equal Opportunity Employer and participates in the E-Verify program.

By proceeding with our application and submitting your information, you acknowledge that you have read our U.S. Personnel Privacy Notice and consent to receive email communication from CareDx.

******** We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.