The Appeals Specialist works directly within GHI systems and extensions to address patients, prescribing physicians, sales force and payers to increase overturned medical necessity or other clinical claim denials to gain maximum coverage of Genomic Health (GHI) products. He/She will handle a large case load, which are generally unique and complex, using comprehensive clinical and resource knowledge to interpret medical records and physician notes, and compose clearly articulated letters of appeal. In addition, he/she will work closely with the Medical Affairs and Managed Care teams to develop targeted appeals strategies.
To perform this job successfully, the ideal candidate is capable of performing each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job.
Language Skills: Ability to read and comprehend instructions, correspondence, and memos. Ability to write correspondence and be persuasive. Ability to effectively present information in one-on-one and small group situations to customers, clients, payors and other employees of the organization.
Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Genomic Health is a global provider of genomic-based diagnostic tests that address the overtreatment of cancer, one of the greatest issues in healthcare today. Our goal is to improve the lives of people with cancer by providing personalized, biological information that helps them get the right treatment at the right time, and to avoid unnecessary treatments and their side effects. In this way, our work is truly life, changing.
Join the Genomic Health Team, and have the unique opportunity to make a difference in the lives of patients with cancer, while developing your career potential. We embrace our unique culture characterized by our Core Values of Community, Truth Seeking, Being Ahead of the Curve and Winning to be the best in the world at what we do. We maintain competitive total rewards programs designed to satisfy our employees’ work life and personal life needs.
All qualified applicants will receive consideration for employment without regard to race, sex, gender identity, color, religion, national origin, protected veteran status, or on the basis of disability.