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Senior Payer Relations Specialist
Location
United States
Posted
18 days ago
Salary
$80.2K - $120.4K / year
Seniority
Senior
Job Description
Senior Payer Relations Specialist
Adaptive Biotechnologies Corp.
• The Sr Payer Relations Specialist will focus on increasing collections from insurance companies by effectively managing payor follow-up and appeals of denied claims. • This position will analyze and resolve payor reimbursement issues through in-depth research and analysis of claim data, payor policies, regulations, and coverage criteria. • This position will work in collaboration with the Market Access team, other cross-functional partners and Adaptive’s revenue cycle providers to develop and implement strategies for achieving maximal reimbursement and cash recovery from commercial payors. • This role will help manage the operational and administrative processes for coding, billing, and payor follow-up - including overseeing appeals, development requests, and payor projects. • Communicate effectively with payors and internal stakeholders to resolve reimbursement issues and ensure optimal payment for Adaptive’s clinical products. • Support revenue and ASP growth in collaboration with the Market Access team and external billing vendor • Stay current with payor policy changes and regulations to ensure accurate and timely reimbursement of claims. • Provide support and guidance to clinical and administrative staff on reimbursement and compliance issues. • Review claims and supporting clinical documents for billing and coding accuracy. • Remains knowledgeable on third-party requirements, and regulatory guidelines at the federal, state, and local levels • Support reduction in denials percentage, claims underpayments and time to adjudication. • Work with data analytics and revenue operations team to refine analytical tools that support process efficiencies and data-driven insights. • Generate and analyze reports to identify trends, areas for improvement and potential revenue opportunities. • Monitor and maintain accurate and up-to-date payor contract information in billing systems.
Job Requirements
- 5-7+ years billing, coding, and reimbursement experience in CLIA laboratory services sector - pathology and oncology industry preferred. Commensurate experience in other healthcare provider settings will be considered.
- Strong knowledge of Medicare, Medicaid, and private insurance reimbursement processes and regulations.
- Proficient knowledge of CMS guidelines
- Excellent interpersonal and communication skills, with the ability to build and maintain positive relationships with insurance payors.
- Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
- Strong problem-solving skills, with the ability to quickly identify and resolve issues affecting payment of claims.
- Knowledge of medical billing and coding practices and procedures.
- Strong computer skills, including proficiency in Microsoft Office and healthcare billing and reimbursement software.
- Proficient knowledge and understanding of use of coding modifiers.
Benefits
- equity grant
- bonus eligible
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