Senior Payer Relations Specialist

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Adaptive Biotechnologies Corp.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2009

🧬 Biotechnology

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 $125M Post-IPO Debt on 2022-09

Biotechnology • Healthcare Insurance • Pharmaceuticals

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

• 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.

🎯 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