Insurance Specialist

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

📋 Description

• Evaluate and investigate delayed or denied claims to ascertain the root cause based on payer explanations of benefits or remittance advice.

• Perform prompt follow-ups with insurance carriers to clarify claim statuses, resolve issues, and secure payments.

• Acquire missing information, rectify coding or billing errors, and submit revised claims or resubmissions.

• Refer unresolved or complex claims to Appeal Specialists or management for further action.

• Research and interpret payer coverage policies, contracts, and medical necessity requirements associated with molecular and NGS testing.

• Record follow-up activities, payer communications, and resolution steps in the billing system.

• Ensure adherence to HIPAA, payer regulations, and internal company policies.

• Collaborate with prior authorization, billing, reimbursement, and client services teams.

• Communicate with providers and internal stakeholders to resolve claim discrepancies or gather necessary information.

• Monitor claim statuses, denial reasons, resolution timelines, and follow-up outcomes.

• Identify trends in denials and delays, and assist in implementing strategies to minimize future denials.

• Offer feedback on workflow and process improvements to enhance revenue cycle efficiency.

• Manage incoming single-case agreements or Letters of Agreement (LOAs) and negotiate suitable reimbursement rates.

• Provide insights on single-case agreement trends to contracting and payer relations teams.

• Carry out additional duties as assigned.

⛳️ Requirements

• High school diploma.

• A minimum of 2 years of experience in insurance follow-up, denial management, medical billing, or revenue cycle operations.

• Comprehensive knowledge of insurance billing processes, denial codes, and payer follow-up workflows.

• Exceptional verbal and written communication skills.

• Strong analytical skills and problem-solving abilities.

• Proficient in billing systems and Microsoft Office Suite.

• Detail-oriented with strong organizational capabilities.

• Ability to independently manage multiple priorities in a fast-paced environment.

• Critical thinker with a proactive stance towards issue resolution.

• Preferred experience in molecular/genetic testing or specialty laboratory billing.

• Preferred experience using Quadax or similar Revenue Cycle Management systems.

• Adaptive is not currently sponsoring candidates who require work authorization support for this position.

🏝️ Benefits

• Equity grant.

• Eligible for bonuses.

• Flexible working hours outside standard times when necessary, including nights, weekends, and holidays.