Senior Clinical Reimbursement Specialist

TL;DR

Senior Clinical Reimbursement Specialist (Healthcare Reimbursement): Managing complex clinical appeals and payer escalations across the revenue cycle with an accent on clinical policy interpretation, high-dollar cases, and scalable reimbursement operations. Focus on developing patient-specific clinical justifications, improving appeal outcomes, mentoring specialists, and supporting automation and AI-enabled workflow initiatives.

Location: Remote; hirify.global participates in E-Verify in the United States.

Salary: $86,098–$107,850 USD annually.

Company

hirify.global is a diagnostics company developing genomic and clinical insights 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.
• Interpret payer medical policies and develop clinically robust, patient-specific appeal documentation for complex and high-dollar cases.
• Own cases through resolution, coordinating with ordering physicians, practice staff, and leadership on reviews, documentation, and escalations.
• Mentor Clinical Reimbursement Specialists through case reviews, coaching, and feedback on appeal quality and payer policy interpretation.
• Analyze denial patterns and payer policy changes, driving process improvements, coverage reviews, and operational remediation.
• Develop SOPs, appeal templates, evidence packets, payer reference guides, and digital transformation initiatives involving automation and AI workflows.

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 subject-matter expertise.

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 in a purpose-driven environment focused on improving cancer care.
• Competitive compensation with potential discretionary bonuses, incentives, and restricted stock units.
• Benefits and career development opportunities within a growing diagnostics company.
• Inclusive workplace recognized as a Certified Great Place to Work in the US and Israel.
• Values emphasize innovation, execution, empathy, integrity, collaboration, and patient impact.