Insurance Benefits Specialist #3425



Accounting & Finance
Durham, NC, USA
Posted on Wednesday, January 10, 2024
GRAIL is a healthcare company whose mission is to detect cancer early, when it can be cured. GRAIL is focused on alleviating the global burden of cancer by developing pioneering technology to detect and identify multiple deadly cancer types early. The company is using the power of next-generation sequencing, population-scale clinical studies, and state-of-the-art computer science and data science to enhance the scientific understanding of cancer biology, and to develop its multi-cancer early detection blood test. GRAIL is headquartered in Menlo Park, CA with locations in Washington, D.C., North Carolina, and the United Kingdom. GRAIL, LLC is a wholly-owned subsidiary of Illumina, Inc. (NASDAQ:ILMN). For more information, please visit
GRAIL is seeking an Clinical Insurance Specialist who is responsible for managing the insurance review and entry into Grail systems and conducting eligibility verifications for coverage of the Grail tests. This position will check eligibility and perform outreach to remediate front end errors and ensure prompt payment from payers. The Insurance Benefit Specialist will work closely with GRAIL’s third-party billing partner and our management team while working closely with the Sales, Customer Experience, Customer Implementation, Finance, and the Customer Service groups to ensure quality, accuracy and efficiencies within billing and reimbursement processes.

You will:

  • Review incoming test requisitions that indicate a bill type of insurance to determine if Grail has contracts in place to bill the payer.
  • Update the bill type to patient pay if Grail is not contracted and potentially communicate to the patient in advance of their being billed.
  • Run eligibility verification for payers Grail does have contracts in place and determine if the patient has active coverage for their date of service.
  • Update the accession with the correct insurance information prior to the test reporting to ensure the correct insurance information is sent to our third-party billing system.
  • Perform outreach to the patient or HCP if the insurance information is invalid or missing correct information to ensure accurate billing and reduce front end errors.
  • Understand insurance company requirements and processes pertaining to eligibility for lab benefits.
  • Display effective and professional communication skills and can navigate meaningful questions and resolve complex problems.
  • Document all interactions and calls within the case management system.
  • Abide by PCI, CLIA, CAP, HIPAA, and other state, federal, and regulatory guidelines.
  • Support the Billing Ops team by providing outreach support to patients and HCP when needed for front-end error resolution and/or back-end claim denials.
  • Work independently and within a team setting
  • Provide services in a high-volume work environment
  • Adhere to SOPs pertaining to medical billing, customer service, and accessioning issue resolution.

Preferred Qualifications

  • A Bachelor’s degree or an equivalent combination of education and experience.
  • Ideal candidate will have 2+ years medical billing experience in the laboratory or in a closely-related field.
  • Strong communication skills with co-workers, managers and customers.
  • Strong organizational skills and meticulous attention to detail.
  • Ability to accept, integrate, and apply constructive feedback in a professional manner.
  • Ability to prioritize tasks and drive results with a high emphasis on quality.
  • Ability to work as part of a team within a highly collaborative environment.
  • Strong computer, internet, and software operation skills.
  • Preferred Qualifications
  • Medical Billing certification from a reputable institution (such as the American Academy of Professional Coders / AAPC) is preferred.
  • Technical computer proficiency (Google Docs, Google Sheets etc.)
Based on the role, colleagues may be eligible to participate in an annual bonus plan tied to company and individual performance, or an incentive plan. We also offer a long-term incentive plan to align company and colleague success over time.
In addition, GRAIL offers a progressive benefit package, including flexible time-off, a 401k with a company match, and alongside our medical, dental, vision plans, carefully selected mindfulness offerings.
GRAIL is an Equal Employment Employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability or any other legally protected status. We will reasonably accommodate all individuals with disabilities so that they can participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation. GRAIL maintains a drug-free workplace.