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Company

Adaptive Biotechnologies Corp. · 8 hours ago

Senior Manager, Reimbursement Operations

United States

Full-time

Remote

Senior Level, Lead/Staff

$127K/yr - $191K/yr

12+ years exp

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Responsibilities

Lead and oversee the Prior Authorization, Eligibility, and Insurance Discovery teams, ensuring timely and accurate processing of authorizations.

Ensure comprehensive insurance eligibility and benefit discovery processes for new and existing patients.

Develop and implement strategies to improve prior authorization approval rates and reduce denials.

Manage the account outreach team to ensure accurate and timely medical record collection for billing and reimbursement.

Oversee client billing processes, ensuring compliance and accuracy in all billing activities.

Develop and monitor processes for Letters of Agreement (LOAs) to align with reimbursement requirements.

Manage appeals and claims follow-up processes, ensuring compliance with all regulatory standards and maximizing successful appeals.

Collaborate with the analytics team to create reports and dashboards that track reimbursement and authorization metrics.

Provide training, guidance, and coaching to team members to foster skill development and compliance with policies.

Identify and implement process improvements to streamline reimbursement workflows and reduce administrative burden.

Serve as point of contact for cross-functional teams in sales, clinical services, and finance for reimbursement operations-related queries.

Collaborate with third-party vendors to optimize software and service solutions for reimbursement operations.

Establish clear goals for the team, align them with organizational objectives, and monitor team performance.

Participate in forecasting and budgeting processes in collaboration with finance and other operational teams.

Ensure compliance with all federal, state, and local laws and regulations regarding billing and reimbursement practices.

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.

Healthcare reimbursement operationsPrior authorization processesMedical billingCodingData analysisInsurance eligibilityBillingAppeals processesCLIA laboratory servicesOncology industryICD-10 codesCPT codesPayer guidelinesCross-functional collaboration

Required

Bachelor’s degree

12+ years of experience in healthcare reimbursement operations

Minimum of 5 years of experience with billing and reimbursement

Extensive experience with prior authorization, insurance eligibility, account outreach, billing, and appeals processes

Strong understanding of medical billing and coding, including knowledge of ICD-10, CPT codes, and payer guidelines

Experience managing and optimizing workflows and processes to improve reimbursement rates

Proven ability to lead and develop high-performing teams

Proficiency in data analysis, with a strong ability to derive insights from metrics to drive improvements

Strong written and verbal communication skills for effective interaction with stakeholders at all levels

Ability to work collaboratively in a cross-functional environment

Preferred

at least 5 years in a management role preferred

billing and reimbursement in CLIA laboratory services sector, oncology industry preferred

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

501-1,000 employees