Appeals Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Analyze denied claims and establish the suitable appeal strategy in accordance with payer guidelines.

• Draft and submit appeal letters along with necessary supporting documentation.

• File appeals through preferred payer channels, whether via online portals, fax, or mail, adhering to payer-specific deadlines.

• Monitor the status of appeals and maintain precise records in the billing system.

• Reach out to insurance companies to verify the receipt of appeals and their progress.

• Elevate unresolved appeals or intricate cases to management for further handling.

• Remain informed about payer policies and appeal requirements related to molecular and genetic testing.

• Ensure that all appeal activities align with HIPAA regulations and industry standards.

• Recognize denial trends and collaborate with reimbursement teams to mitigate future occurrences.

• Work in conjunction with prior authorization, billing, and payer relations teams.

• Liaise with providers to obtain additional clinical information as necessary.

• Execute other responsibilities as assigned.

⛳️ Requirements

• A high school diploma is mandatory.

• Minimum of 2 years’ experience in insurance appeals, medical billing, or revenue cycle operations.

• Comprehensive understanding of insurance processes and denial management.

• Exceptional written and verbal communication abilities.

• Proficient in billing systems and the Microsoft Office Suite.

• Highly detail-oriented and organized.

• Capable of working independently while managing multiple priorities.

• Strong problem-solving and critical thinking abilities.

• Willingness to work outside of standard hours when necessary, including nights, weekends, and holidays.

• Adaptive is not currently providing sponsorship for candidates needing work authorization support for this role.

🏝️ Benefits

• Equity grant.

• Bonus eligibility.

• Affirmative Action and Equal Opportunity Employer.

• Support for reasonable accommodations for disabled job seekers.