Appeals Specialist

Position Overview

The Appeals Specialist is responsible for managing insurance claim appeals to ensure proper reimbursement for molecular and genetic testing services. This role involves preparing and submitting appeal documentation, following up with payer’s post-submission, and collaborating with internal teams to resolve claim denials efficiently. The specialist serves as a key contributor to revenue cycle success and payer compliance.

Key Responsibilities and Essential Functions

Appeal Submission

• Review denied claims and determine appropriate appeal strategy based on payer guidelines.
• Prepare and submit appeal letters with supporting documentation (payer forms, medical records, prior authorization details, clinical justification).
• Ensure appeals are submitted via the payers’ preferred format (portal, fax, mail) within payer-specific timelines to avoid missed opportunities.

Post-Submission Follow-Up

• Track appeal status and maintain accurate records in the billing system.
• Contact insurance companies to confirm receipt and progress of appeals.
• Escalate unresolved appeals or complex cases to management as needed.

Research & Compliance

• Stay current on payer policies and appeal requirements for molecular and genetic testing.
• Ensure all appeal activities comply with HIPAA and regulatory standards.
• Identify trends in denials and collaborate with reimbursement teams to reduce future occurrences.

Collaboration & Communication

• Work closely with prior authorization, billing, and payer relations teams to gather necessary documentation.
• Communicate with providers when additional clinical information is required for successful appeal.

All other duties as assigned.

Position Requirements (Education, Experience, Other)

Required

• High school diploma required.
• 2 years in insurance appeals, medical billing, or revenue cycle operations.
• Strong understanding of insurance processes and denial management.
• Excellent written and verbal communication skills.
• Proficiency in billing systems and Microsoft Office Suite.
• Detail-oriented and organized.
• Ability to work independently and manage multiple priorities.
• Strong problem-solving and critical thinking skills.

Preferred

• Associate’s or Bachelor’s degree.
• Experience with molecular/genetic testing or specialty lab billing.

Working Conditions

Flexibility to work out of standard hours when necessary, including nights & weekends, holiday etc.

Physical Requirements

This job is primarily completing work from a desk.

Compensation

Hourly Rate: $22.74 - $27.79

Other Compensation Elements Include

• Equity grant
• Bonus eligible

Legal & EEO Statements

Adaptive Biotechnologies is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

Adaptive is not currently sponsoring candidates requiring work authorization support for this position.

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