---
title: 'Senior Clinical Reimbursement Specialist at Veracyte'
canonical: 'https://feeny.ai/job/senior-clinical-reimbursement-specialist-veracyte-remote-tp7qyyv7vpc7'
type: 'job'
last_seen: '2026-09-12'
---

# Senior Clinical Reimbursement Specialist at Veracyte

- **Company:** Veracyte
- **Location:** Remote
- **Compensation:** $86k–$138k
- **Work type:** remote
- **Posted:** 2026-09-11
- **Last confirmed live:** 2026-09-12
- **Apply:** https://veracyte.com/job-detail?gh_jid=5225509007

## Job description

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 point of contact for complex patient- or provider-facing inquiries, ensuring accurate, empathetic, and compliant communication.
- Support digital transformation initiatives, including automation and AI/agentic workflow pilots that improve appeal readiness scoring and clinical documentation review.
- Represent the Clinical Reimbursement team in cross-functional initiatives and special projects that support evolving reimbursement and operational priorities.

Who You Are:

## Qualifications

Required

- Active clinical licensure (e.g., RN, NP).
- Associate or Bachelor's degree in nursing.
- 3–5 years of experience in healthcare reimbursement, revenue cycle operations, or payer-facing roles.
- 2+ years of experience in prior authorization, denial management, or appeals -including pre-service and post-service workflows.
- Advanced understanding of payer medical policies, prior authorization, claims adjudication, denials, and appeals - including Level 1, Level 2, and external review processes.
- Demonstrated ability to independently manage complex, ambiguous, or high-dollar cases without routine escalation.
- Proven ability to translate complex payer medical policy criteria into patient-specific clinical justification.
- Strong critical thinking and analytical skills, including the ability to interpret incomplete denial information and drive appropriate next steps without direction.
- Experience contributing to the development of SOPs, appeal letter templates, workflow tools, or other operational assets within a reimbursement environment.
- Demonstrated ability to mentor or provide informal leadership to peers, including case review, coaching, or SME support.
- Excellent communication and collaboration skills, with the ability to influence cross-functional discussions and convey clinical/reimbursement concepts to both clinical and non-clinical stakeholders.
- Demonstrates ownership of cases through resolution, including follow-up, coordination, and appropriate escalation.
- Comfortable working in an evolving environment with shifting priorities, ambiguity, and the need to build systems where none exist.

## Preferred

- Prior experience in oncology diagnostics, laboratory services, or complex/specialty reimbursement environments.
- Experience leading or contributing to process improvement, workflow redesign, or operational scaling initiatives within the revenue cycle.
- Familiarity with digital transformation initiatives in healthcare operations (automation, AI/agentic workflows, workflow tools, system integration).
- Relevant certification (CPC, CRCR, CHFP, Lean/Six Sigma) or Master's degree (MSN, MHA, MBA).

#LI-Remote

For San Diego based candidates, the salary range is $113,276 - $125,000. For South San Francisco based candidates, the salary range is $119,110 - $137,657. For candidates in other locations in the U.S., the salary range is $86,098 - $107,850.

The final salary offered to a successful candidate will be dependent on several factors that may include but are not limited to years of experience, skillset, geographic location, industry, education, etc. Base pay is one part of the Total Package that is provided to compensate and recognize employees for their work, and this role may be eligible for additional discretionary bonuses/incentives, and restricted stock units.

Pay range $86,098—$137,657 USD

## What We Can Offer You

Veracyte is a growing company that offers significant career opportunities if you are curious, driven, patient-oriented and aspire to help us build a great company. We offer competitive compensation and benefits, and are committed to fostering an inclusive workforce, where diverse backgrounds are represented, engaged, and empowered to drive innovative ideas and decisions. We are thrilled to be recognized as a 2024 Certified™ Great Place to Work® in both the US and Israel - a testament to our dynamic, inclusive, and inspiring workplace where passion meets purpose.

## About Veracyte

Veracyte (Nasdaq: VCYT) is a global diagnostics company whose vision is to transform cancer care for patients all over the world. We empower clinicians with the high-value insights they need to guide and assure patients at pivotal moments in the race to diagnose and treat cancer. Our Veracyte Diagnostics Platform delivers high-performing cancer tests that are fueled by broad genomic and clinical data, deep bioinformatic and AI capabilities, and a powerful evidence-generation engine, which ultimately drives durable reimbursement and guideline inclusion for our tests, along with new insights to support continued innovation and pipeline development. For more information, please visit [www.veracyte.com](https://cts.businesswire.com/ct/CT?id=smartlink&url=https%3A%2F%2Fwww.veracyte.com%2F&esheet=54340020&newsitemid=20251015446872&lan=en-US&anchor=www.veracyte.com&index=5&md5=4d48386b00ece1531372e2e593d7cd2d) or follow us on [LinkedIn](https://cts.businesswire.com/ct/CT?id=smartlink&url=https%3A%2F%2Fwww.linkedin.com%2Fcompany%2Fveracyte%2F&esheet=54340020&newsitemid=20251015446872&lan=en-US&anchor=LinkedIn&index=6&md5=234cba826cb637f449d2722139f551ef) or https://cts.businesswire.com/ct/CT?id=smartlink&url=https%3A%2F%2Fx.com%2Fveracyte%3Fs%3D11&esheet=54340020&newsitemid=20251015446872&lan=en-US&anchor=X+%28Twitter%29&index=7&md5=20ead95735af622bf261b20735515b66.

Veracyte, Inc. is an Equal Opportunity Employer and will consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disability status. Veracyte participates in E-Verify in the United States. View our [CCPA Disclosure Notice](https://www.veracyte.com/legal/privacy-statement-for-california-residents/)

If you receive any suspicious alerts or communications through LinkedIn or other online job sites for any position at Veracyte, please exercise caution and promptly report any concerns to careers@veracyte.com

## About Veracyte

## Company Overview
- **One-liner**: Veracyte is a global cancer diagnostics company that develops molecular tests to help clinicians make more informed care decisions by analyzing the unique biology of each patient’s tumor.
- **Entity Type**: Public (traded on NASDAQ; ticker not explicitly confirmed in provided sources)
- **Headquarters**: South San Francisco, California, United States (with additional high-complexity clinical labs in San Diego, California, and Austin, Texas)
- **Founded**: Not publicly available in provided sources
- **Founders**: Not publicly available in provided sources

## Core Business
- **Primary industry**: Cancer diagnostics / molecular genomics / precision oncology
- **Target customers**: B2B – clinicians, hospitals, health systems, and laboratory service providers; B2C indirectly through patient care decisions
- **Mission statement**: “Transform cancer care for patients all over the world” (from about page)

## Products & Services
- **Afirma Genomic Sequencing Classifier**: A test for thyroid nodules to help avoid unnecessary surgery (SaaS/Service)
- **Decipher Prostate Genomic Classifier**: The only gene expression test included in the NCCN Clinical Practice Guidelines for prostate cancer (Service)
- **Decipher Bladder Genomic Classifier**: A test for bladder cancer to guide treatment decisions (Service)
- **Prosigna Breast Risk of Recurrence (ROR) Test**: Recently launched commercially in the U.S. (June 2026) to identify high-risk breast cancer patients who may safely avoid chemotherapy (Service)
- **TrueMRD Monitoring Test for MIBC**: Minimal residual disease monitoring for muscle-invasive bladder cancer; secured Medicare coverage in May 2026 (Service)
- **Provider Ordering Portal**: Digital platform for clinicians to order Veracyte tests (SaaS)
- **Scientific Publications & Evidence Engine**: AI-assisted data mining, multimodality analysis, and bioinformatics to support ongoing test development (R&D platform)

## Market Standing
- **Valuation/Market Cap**: Not publicly available in provided sources (public company; financial specifics not included in searched materials)
- **Key Metric**: Over 900,000 patients have benefited from Veracyte’s genomic tests across multiple cancer types; more than 600 peer-reviewed publications validate the platform’s clinical utility
- **Notable Investors/Partners**: NCCN (Decipher Prostate included in guidelines); collaborators on landmark OPTIMA trial (Prosigna); Medicare (coverage for TrueMRD)
- **Growth Signals**:
  - Commercial launch of Prosigna in the U.S. (June 2026)
  - Medicare coverage for TrueMRD monitoring test (May 2026)
  - Three high-complexity clinical labs operating in San Diego, South San Francisco, and Austin
  - Headcount of over 800 team members serving clinicians and patients globally
  - Landmark OPTIMA trial results published, demonstrating Prosigna’s ability to identify patients who can safely avoid chemotherapy

## Competitive Advantages
- **Evidence depth**: Only gene expression test included in NCCN Guidelines for prostate cancer; >600 peer-reviewed publications
- **Multi-cancer portfolio**: Covers thyroid, prostate, breast, bladder, and lung cancer, offering a comprehensive platform for oncology decision-making
- **Regulatory & reimbursement momentum**: Recent Medicare coverage for TrueMRD and U.S. commercial launch of Prosigna demonstrate market adoption
- **Integrated platform**: Combines genomics, transcriptomics, real-world data, and AI-driven analysis to continuously generate evidence and refine tests

## Strategic Focus
- **Geographic and product expansion**: Commercializing the Prosigna test in the U.S. and expanding reimbursement for monitoring tests like TrueMRD
- **Real-world evidence generation**: Using their evidence engine (AI, multimodal analysis, bioinformatics) to support new indications and clinical utility
- **Platform scalability**: Building a robust diagnostics platform that can be applied to additional cancer types and clinical questions
- **Clinical trial partnerships**: Leveraging studies like OPTIMA to validate clinical value and drive guideline inclusion

## Why Work Here
- **Culture**: Values-driven (“We care deeply,” “We seek a better way,” “We make it happen,” “We are stronger together”); recognized as a Great Place to Work® and listed on Forbes Mid-Cap list
- **Work model**: Hybrid/remote options available; positions in labs, offices, field locations, and remote work (as seen on careers page)
- **Benefits** (U.S. examples): Medical, dental, vision, mental health support, paid time off, parental leave, 401(k) with employer match, employee stock purchase plan (ESPP), tuition reimbursement, commuter benefits, Calm app subscription, gym reimbursement, and family care support
- **Mission-driven**: Opportunity to directly impact cancer patients’ lives by developing and delivering diagnostic tests that provide clearer answers for clinicians
- **Growth opportunities**: Roles span research, clinical development, bioinformatics, lab services, regulatory affairs, data engineering, and more

## Sources
1. [Veracyte Home Page](https://www.veracyte.com/)
2. [Veracyte About Page](https://www.veracyte.com/company/about-veracyte/)
3. [Veracyte Careers Page](https://www.veracyte.com/company/careers/)
4. [Veracyte Working at Veracyte Page](https://www.veracyte.com/company/working-at-veracyte/)
5. [Veracyte LinkedIn Profile](https://www.linkedin.com/company/veracyte)

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