Senior Payer Relations Specialist Full Time

Description:

• 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.
• Remain 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.