Senior Payer Relations Specialist

5 days ago

Seattle, Washington, United States Adaptive Biotechnologies Full time
Job Title: Senior Payer Relations Specialist

At Adaptive Biotechnologies, we are seeking a highly skilled Senior Payer Relations Specialist to join our team. This role will play a critical part in increasing collections from insurance companies by effectively managing payor follow-up and appeals of denied claims.

Key Responsibilities:
  • 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.
Preferred Qualifications:
  • CPC or equivalent certification.
  • Knowledge of GTR, GTU and PLA coding.
  • Knowledge of PAMA.
  • Proficiency in Salesforce, Tableau, EHR and revenue cycle systems.
Compensation:

Salary Range: $79,400 - $119,200

Other compensation elements include: equity grant, bonus eligible

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