Reimbursement Specialist – Appeals

🔥 0 minutes ago

🌲 North Carolina, Massachusetts – Remote

🌲 North Carolina – Remote 🍂 Massachusetts – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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NAVERIS

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2017

🧬 Biotechnology

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Biotechnology • Healthcare Insurance • Pharmaceuticals

NAVERIS is a biotechnology company focused on the early detection of viral cancers through innovative technologies. Their flagship product, NavDx®, is a highly sensitive liquid biopsy that enables earlier identification and monitoring of HPV-related cancers compared to traditional methods. With a mission to improve patient outcomes and transform cancer detection, Naveris leverages proprietary technology for non-invasive blood tests that provide real-time insights into cancer recurrence and treatment responses.

📋 Description

• Support post-submission reimbursement activities • Focus on denials management and appeals • Investigate denials, prepare and submit appeals • Follow up with payers to ensure timely and accurate reimbursement • Manage various denial types and prepare higher-level appeals • Review and interpret Explanation of Benefits (EOBs) • Contact insurance companies and utilize payer portals • Submit corrected claims and appeals in accordance with payer guidelines • Maintain accurate documentation of denials and appeals actions • Assist in developing payer-specific appeals workflows • Communicate with patients and providers regarding appeals related questions • Critically assess challenging situations and escalate when appropriate • Ensure compliance with billing regulations and company policies

🎯 Requirements

• 4+ years of experience in reimbursement, denials management, or revenue cycle management • Bachelor’s degree or equivalent experience • Experience with Xifin, Quadax, or Telcor preferred • Strong understanding of medical benefit structures • Working knowledge of CPT, ICD-10, and HCPCS coding • Proven ability to analyze denials, identify root causes, and resolve issues effectively • Strong attention to detail, judgment, and follow-through • Excellent verbal and written communication skills with a customer service mindset • Strong troubleshooting, organizational, and time-management skills • Ability to adapt to changing business needs • Self-starter who can work independently

🏖️ Benefits

• Competitive compensation • Work/life balance • Remote work opportunities