Job Description

Job Description

Job Description

About Us

Would you like to be part of a fast-growing team that believes no one should have to succumb to HPV-driven cancers? Naveris, a biotech startup based near Boston, MA, is looking for a Credentialing Specialist team member to help us develop our next great product for patients at risk of developing viral cancers. Our flagship test, NavDx, is a breakthrough blood-based DNA test for HPV cancers, clinically proven and already trusted by hundreds of physicians and institutions across the U.S.

Opportunity

We are looking for a conscientious, knowledgeable individual to join our team, and be responsible for handling the varied aspects of the reimbursement process. We use an outsourced RCM vendor, but need additional oversight which may include focusing on accurate claims submissions and appeals submissions from all payers including Medicare, Medicaid, and commercial insurance plans.

Job Responsibilities

Reporting to the Senior Director, RCM and Payer Engagement, you will be supporting the Reimbursement department. This position is remote. Duties may include:

Job Responsibilities

• Complete provider credentialing and enrollments with third-party carriers and government health plans.
• Review provider credentialing and enrollments to ensure completeness and accuracy.
• Monitor applications and follow-up in a timely manner.
• Document, maintain and crosscheck client credentials in multiple databases, and other third-party databases, as applicable.
• Create, update and track provider information in the internal credentialing system to ensure that credentials are completed timely and correctly.
• Meet or exceed required timeframes for provider communications, enrollments, and follow-ups.
• Maintain quality working relationships with internal and external customers.

Qualifications:

• 3-5 years of experience in credentialing and enrollment
• Knowledge of Commercial Insurance and Government Payor guidelines.
• Ability to plan, organize, and complete work with competing priorities.
• Takes accountability for personal productivity and quality of output.
• Organized and detail-oriented with strong communication and problem-solving skills.
• Ensure all required documentation is complete and accurate to avoid delays in authorization.
• Track appeal outcomes and follow up on unresolved cases to ensure successful resolution.
• Collaborate closely with the entire reimbursement department and market access team.
• Provide regular updates to management on the status of authorizations and appeals.
• Stay informed of changes in insurance guidelines and payer requirements.
• Communicate effectively with internal and external stakeholders.
• The job may have added responsibilities as assigned. All job duties must be performed in a manner that demonstrates the company Leadership Attributes and support of the Mission & Values of the company.

Compliance Responsibilities

Health Insurance Portability and Accountability Act (HIPAA) is a federal law that describes the national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. All roles at Naveris require compliance with legal and regulatory requirements of HIPAA and acceptance and adherence to all policies and standards at Naveris. Personnel acknowledges they are personally responsible for reporting any suspected violations or abuse and are required to complete HIPAA training when joining the company.

Why Naveris?

In addition to our great team and advanced medical technology, we offer our employees competitive compensation, work/life balance, remote work opportunities, and more!

Naveris is an Equal Opportunity Employer

Naveris is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We don’t just accept differences - we celebrate and support them. We do not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

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