Senior Clinical Reimbursement Specialist

Location: Remote within the United States. Salary ranges vary by location: San Diego $113,276–$125,000; South San Francisco $119,110–$137,657; other U.S. locations $86,098–$107,850.

Salary: $86,098–$137,657 USD annually, plus potential discretionary bonuses, incentives, and restricted stock units.

Company

hirify.global is a global diagnostics company developing genomic and clinical solutions to transform cancer care and support clinical decision-making.

What you will do

• Manage complex pre-service and post-service appeals across Level 1, Level 2, and external review pathways.
• Develop clinically robust appeal documentation and translate payer policies into patient-specific clinical justification.
• Coordinate with ordering physicians and practice staff on peer-to-peer reviews, supplemental documentation, and required forms.
• Mentor Clinical Reimbursement Specialists and provide case review, coaching, and policy guidance.
• Analyze denial patterns, payer behavior, and appeal outcomes to improve overturn rates and revenue capture.
• Develop templates, evidence packets, payer guides, SOPs, and automation or AI-enabled workflow improvements.

Requirements

• Active clinical licensure, such as RN or NP.
• Associate or bachelor's degree in nursing.
• 3–5 years of experience in healthcare reimbursement, revenue cycle operations, or payer-facing roles.
• At least 2 years of experience with prior authorization, denial management, or pre-service and post-service appeals.
• Advanced knowledge of payer medical policies, claims adjudication, denials, appeals, and external review processes.
• Strong independent judgment, analytical ability, communication skills, and experience mentoring peers or providing informal leadership.

Nice to have

• Experience in oncology diagnostics, laboratory services, or complex and specialty reimbursement.
• Experience with process improvement, workflow redesign, or revenue-cycle scaling.
• Familiarity with healthcare automation, AI or agentic workflows, workflow tools, and system integration.
• CPC, CRCR, CHFP, Lean/Six Sigma certification or a master's degree.

Culture & Benefits

• Remote work within the United States.
• Competitive compensation and benefits.
• Potential discretionary bonuses, incentives, and restricted stock units.
• Inclusive, purpose-driven environment focused on improving cancer care.
• Values include bold problem-solving, execution, empathy, integrity, and collaboration.