Senior Payer Relations Specialist
The Senior Payer Relations Specialist at Adaptive Biotechnologies is responsible for enhancing collections from insurance companies by managing payer follow-ups and appealing denied claims. This role involves analyzing and resolving reimbursement issues through detailed research of claim data, payer policies, regulations, and coverage criteria. The specialist will collaborate with the Market Access team and revenue cycle providers to develop strategies aimed at maximizing reimbursement and cash recovery from commercial payers.
Key responsibilities include effective communication with payers and internal stakeholders to resolve reimbursement issues, supporting revenue growth in collaboration with the Market Access team and external billing vendors, and staying updated on payer policy changes to ensure accurate and timely claim reimbursements. The role also involves providing guidance to clinical and administrative staff on reimbursement and compliance issues, reviewing claims for billing and coding accuracy, and working with data analytics teams to refine tools that support process efficiencies and data-driven insights.
The ideal candidate will have 5-7 years of experience in billing, coding, and reimbursement within the CLIA laboratory services sector, preferably in pathology and oncology. A strong knowledge of Medicare, Medicaid, and private insurance reimbursement processes and regulations is essential, along with proficiency in CMS guidelines. Excellent interpersonal and communication skills are required to build and maintain positive relationships with insurance payers. The ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment is crucial. Strong problem-solving skills and knowledge of medical billing and coding practices are also necessary.
Compensation for this position includes a salary range of $79,400 to $119,200, along with eligibility for equity grants and bonuses. Additional benefits include company-paid life and AD&D insurance, short and long-term disability coverage, and paid time off and vacation policies. Adaptive Biotechnologies is committed to building diverse, equitable, and inclusive teams across the organization and encourages candidates to apply even if they do not meet all the listed qualifications.