Senior Clinical Reimbursement Specialist

At Veracyte , we offer exciting career opportunities for those interested in joining a pioneering team that is committed to transforming cancer care for patients across the globe. Working at Veracyte enables our employees to not only make a meaningful impact on the lives of patients, but to also learn and grow within a purpose driven environment. This is what we call the Veracyte way – it’s about how we work together, guided by our values, to give clinicians the insights they need to help patients make life-changing decisions. Our Values: • We Seek A Better Way : We pursue bold ideas, embrace complexity, and keep pushing forward. • We Make It Happen : We act with urgency, deliver with excellence, and always find a way. • We Are Stronger Together : We engage with empathy, align around what's best for Veracyte, and celebrate as one team. • We Care Deeply : We show up with integrity, kindness, and respect for one another. The Position: We are seeking an experienced Senior Clinical Reimbursement Specialist to serve as a clinical subject matter expert on our Clinical Reimbursement Operations team. In this role, you will independently manage complex pre- and post-service appeals, mentor junior team members, and drive process improvements that measurably improve overturn rates and revenue capture across the revenue cycle. You will apply advanced clinical judgment and deep payer policy expertise to handle the team's most complex, high-dollar, and precedent-setting cases - including Level 2 appeals, external reviews, and payer escalations. Beyond individual casework, you will contribute to workflow design, SOP development, and cross-functional initiatives that strengthen the team's overall performance. Success in this role requires advanced knowledge of reimbursement systems (including payer utilization management and claims adjudication), fluency in payer medical policies, sound and independent clinical judgment on complex cases, and the ability to influence outcomes through both direct case ownership and informal leadership. Primary Duties and Responsibilities • Independently manage complex pre- and post-service appeals across Level 1, Level 2, and external review pathways, including the review, development, and submission of clinically robust appeal documentation. • Serve as a clinical subject matter expert on payer medical policies, translating complex policy criteria into patient-specific clinical justification and guiding appeal strategy for high-dollar, ambiguous, or precedent-setting cases. • Own end-to-end resolution of assigned cases, including follow-up, coordination with ordering providers, and appropriate escalation to leadership when warranted. • Partner with ordering physicians and practice staff to coordinate peer-to-peer reviews, gather supplemental clinical documentation, secure Authorized Representative forms and signatures, and support collaborative initiatives that strengthen appeal outcomes. • Mentor and provide informal guidance to Clinical Reimbursement Specialists, including case review, appeal letter quality feedback, and coaching on payer policy interpretation. • Lead analysis of denial patterns and appeal outcomes to identify root causes, and drive upstream feedback to reduce future denials. • Contribute directly to the development and refinement of appeal letter templates, clinical evidence packets, payer reference guides, and other scalable operational tools. • Monitor payer behavior and policy changes across all lines of business; flag material changes and partner with leadership on remediations, coverage reviews, and payer escalations. • Support the maintenance and continuous improvement of SOPs, ensuring workflows remain consistent, compliant, and scalable as the team grows. • Serve as p