Insurance Specialist

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $22 - $27 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔒 Insurance

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Adaptive Biotechnologies Corp.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2009

🏥 Healthcare

🧬 Biotechnology

⚕️ Healthcare Insurance

💰 $125M Post-IPO Debt on 2022-09

Healthcare • Biotechnology • Healthcare Insurance

Adaptive Biotechnologies Corp. is a leader in immune-driven medicine, aiming to revolutionize disease detection and treatment. By utilizing the adaptive immune system, the company develops diagnostic and therapeutic solutions powered by its innovative Immune Medicine platform. They offer clinical diagnostics, particularly in Minimal Residual Disease (MRD) testing, and engage in drug discovery and therapeutic development through adaptive immunosequencing technologies. Their biopharma services support the progression of clinical trials and the development of transformative medicines. Adaptive Biotechnologies leverages the complex biology of the immune system, decoding it to advance medical science and improve patient outcomes.

📋 Description

• Review and analyze delayed or denied claims to determine root cause based on payer explanation of benefits or remittance advice • Conduct timely follow up with insurance carriers to clarify claim status, resolve issues, and secure payment • Obtain missing information, correct coding or billing errors, and submit corrected claims or resubmissions • Escalate unresolved or complex claims to Appeal Specialists or management • Research and interpret payer coverage policies, contracts, and medical necessity requirements related to molecular and NGS testing • Document follow up activity, payer communication, and resolution steps within the billing system • Ensure compliance with HIPAA, payer rules, 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 obtain information • Track claim statuses, denial reasons, resolution timelines, and follow up outcomes • Identify denial and delay trends and help implement strategies to reduce future denials • Provide workflow and process improvement feedback to enhance revenue cycle efficiency • Manage incoming single-case agreements or LOAs and negotiate appropriate reimbursement rates • Provide single-case agreement trends to contracting and payer relations teams • Perform other duties as assigned

🎯 Requirements

• High school diploma • 2 years of experience in insurance follow up, denial management, medical billing, or revenue cycle operations • Strong knowledge of insurance billing processes, denial codes, and payer follow up workflows • Excellent verbal and written communication skills • Strong problem solving and analytical abilities • Proficiency with billing systems and Microsoft Office Suite • Detail oriented with strong organizational skills • Ability to manage multiple priorities independently in a fast-paced environment • Critical thinker with a proactive approach to issue resolution • Experience with molecular/genetic testing or specialty laboratory billing preferred • Experience using Quadax or similar RCM systems preferred • Adaptive is not currently sponsoring candidates requiring work authorization support for this position

🏖️ Benefits

• Equity grant • Bonus eligible • Flexible work outside standard hours when necessary, including nights, weekends, and holidays