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Company

Adaptive Biotechnologies Corp. · 1 day ago

Senior Payer Relations Specialist

United States

Full-time

Remote

Mid, Senior Level

$79K/yr - $119K/yr

5+ years exp

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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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Billing experienceCoding experienceReimbursement experienceMedicare knowledgeMedicaid knowledgePrivate insurance knowledgeCMS guidelines knowledgeMedical billing practicesCoding modifiers knowledgeMicrosoft Office proficiencyHealthcare billing softwareCPC certificationGTR knowledgeGTU knowledgePLA coding knowledgePAMA knowledgeSalesforce proficiencyTableau proficiencyEHR proficiencyRevenue cycle systems proficiency

Required

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

CPC or equivalent certification

Knowledge of GTR, GTU and PLA coding

Knowledge of PAMA

Proficiency in Salesforce, Tableau, EHR and revenue cycle systems

Benefits

Equity grant

Bonus eligible

Company

Adaptive Biotechnologies Corp.

Glassdoor

2.8

Adaptive Biotechnologies is a pioneer and leader in immune-driven medicine that aims to improve people’s lives by learning from the wisdom of their adaptive immune systems.

Founded in 2009

Seattle, Washington, USA

501-1000 employees