Senior Payer Relations Specialist

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

📋 Description

• The Senior Payer Relations Specialist will concentrate on enhancing collections from insurance providers by efficiently managing payor follow-up and appeals for denied claims.

• This role will involve analyzing and resolving payor reimbursement challenges through thorough research and examination of claim data, payor policies, regulations, and coverage criteria.

• Collaboration with the Market Access team, cross-functional partners, and Adaptive’s revenue cycle providers will be essential to develop and implement strategies aimed at maximizing reimbursement and cash recovery from commercial payors.

• This position will assist in managing the operational and administrative aspects of coding, billing, and payor follow-up, which includes supervising appeals, development requests, and payor projects.

• Effectively communicate with payors and internal stakeholders to resolve reimbursement challenges and guarantee optimal payment for Adaptive’s clinical products.

• Contribute to revenue and ASP growth in partnership with the Market Access team and external billing vendors.

• Stay informed on payor policy updates and regulations to ensure accurate and timely reimbursement of claims.

• Provide support and guidance to clinical and administrative staff regarding reimbursement and compliance matters.

• Review claims and associated clinical documents to ensure billing and coding accuracy.

• Maintain a strong understanding of third-party requirements and regulatory guidelines at federal, state, and local levels.

• Aid in reducing denial rates, claims underpayments, and time to adjudication.

• Collaborate with the data analytics and revenue operations team to enhance analytical tools that promote process efficiencies and data-driven insights.

• Generate and assess reports to identify trends, opportunities for improvement, and potential revenue streams.

• Oversee and ensure accurate and current payor contract information is maintained in billing systems.

⛳️ Requirements

• 5-7+ years of experience in billing, coding, and reimbursement within the CLIA laboratory services sector, preferably in pathology and oncology. Equivalent experience in other healthcare provider settings will also be considered.

• Comprehensive understanding of Medicare, Medicaid, and private insurance reimbursement processes and regulations.

• Proficient knowledge of CMS guidelines.

• Exceptional interpersonal and communication abilities, with a talent for building and nurturing positive relationships with insurance payors.

• Capacity to work independently, prioritize tasks, and meet deadlines in a dynamic environment.

• Strong problem-solving skills, with the capability to swiftly identify and address issues affecting claim payments.

• Familiarity with medical billing and coding practices and procedures.

• Advanced computer skills, including proficiency in Microsoft Office and healthcare billing and reimbursement software.

• In-depth knowledge and understanding of coding modifiers and their application.

🏝️ Benefits

• Equity grant

• Bonus eligible