About the job
Join Adaptive Biotechnologies and be at the forefront of Immune Medicine. Our mission is to leverage the adaptive immune system to revolutionize disease diagnosis and treatment.
As a member of the Adaptive team, you will have the chance to impact lives positively. Collaborating with passionate and innovative colleagues, you will create a career-defining experience.
It’s time to embark on your next adventure. Discover your unique story with Adaptive.
Position Overview
The Insurance Appeals Specialist plays a crucial role in managing the process of insurance claim appeals, ensuring accurate reimbursement for molecular and genetic testing services. Key responsibilities include preparing and submitting appeal documentation, following up with payers post-submission, and collaborating with internal teams to efficiently address claim denials. This position is vital to our revenue cycle management and compliance with payers.
Key Responsibilities and Essential Functions
Appeal Submission
- Examine denied claims and formulate an effective appeal strategy based on payer guidelines.
- Draft and submit appeal letters accompanied by necessary documentation (payer forms, medical records, prior authorization details, clinical justifications).
- Ensure appeals are submitted in the payers’ preferred formats (portal, fax, mail) within specific timelines to maximize success.
Post-Submission Follow-Up
- Monitor the status of appeals and maintain detailed records in the billing system.
- Engage with insurance companies to confirm receipt and progress of appeals.
- Escalate unresolved appeals or complex cases to management when necessary.
Research & Compliance
- Remain updated on payer policies and appeal requirements for molecular and genetic testing.
- Ensure all appeal activities adhere to HIPAA and regulatory standards.
- Analyze denial trends and collaborate with reimbursement teams to prevent future issues.
Collaboration & Communication
- Coordinate closely with prior authorization, billing, and payer relations teams to collect required documentation.
- Interface with providers for additional clinical information needed for successful appeals.
Perform other duties as assigned.