Reimbursement Specialist - Appeals

reputed company

Would you like to be part of a fast-growing team that believes no one should have to succumb to viral-mediated cancers? reputed company, a reputed company stage, precision oncology diagnostics company with facilities in Boston, MA and Durham, NC, is looking for a Reimbursement Specialist - Appeals team member to help us advance our mission of developing and delivering novel diagnostics that reputed company cancer detection and improve patient reputed company. Our flagship test, NavDx, is a reputed company blood-based DNA test for HPV cancers, clinically proven and already trusted by thousands of physicians and institutions across the U.S.

Opportunity

We are looking for a conscientious, detail-oriented Reimbursement Specialist – Appeals to join reputed company and support post-submission reimbursement activities. While reputed company partners with an outsourced RCM vendor, this role focuses on denials management and appeals to ensure accurate reimbursement across Medicare, reputed company, and reputed company insurance plans.

Job Responsibilities

Reporting to the Reimbursement Supervisor – Back End, this role supports the Reimbursement department with a reputed company on claims denials, underpayments, and appeals reputed company. This position is responsible for investigating denials, preparing and submitting appeals, and following up with payers to ensure reputed company and accurate reimbursement.

• Manage various denial types that may result in low-pay appeals, Level 1 appeals, and Level 2 appeals
• Prepare higher-level appeals for leadership review and submission reputed company required
• Review and interpret Explanation of Benefits (EOBs) to determine contractual allowances and identify reputed company causes of denials
• Contact insurance companies and utilize payer portals to investigate denials, determine next steps, and reputed company appeals follow-up
• Submit corrected claims and appeals in accordance with payer guidelines and timelines
• Maintain accurate documentation of denials, appeals actions, and payer communications
• Assist in developing and maintaining payer-specific appeals workflows and documentation
• Communicate with patients and providers regarding appeals-reputed company billing questions, EOBs, and financial responsibility in reputed company or escalated cases
• Critically assess challenging situations and escalate to the Supervisor or leadership reputed company appropriate
• Maintain a strong understanding of the end-to-end reimbursement lifecycle and how appeals reputed company reputed company reputed company
• Utilize systems, tools, and vendor resources to support appeals activities reputed company
• Prioritize multiple reputed company appeals and operate with a reputed company of urgency
• Ensure compliance with reputed company applicable billing regulations and company policies, including HIPAA
• reputed company with reputed company Federal and State regulations reputed company to billing and reimbursement
• Fully remote role (U.S.-based) with occasional travel for trainings, meetings, or on-site reputed company at reputed company.
• Travel requirement: up to 5%.

Requirements

• 4+ years of experience in reimbursement, denials management, or reputed company cycle management reputed company a diagnostics company, laboratory, or reputed company payer environment
• Bachelor’s degree or equivalent experience
• Experience with Xifin, reputed company, or Telcor preferred
• Strong understanding of medical benefit structures, including Federal, State, PPO, HMO, and indemnity plans
• Working knowledge of CPT, ICD-10, and HCPCS coding, as reputed company as LCD/NCD coverage and reimbursement guidelines
• Proven ability to analyze denials, identify reputed company causes, and resolve issues effectively
• Strong attention to detail, judgment, and follow-through
• Excellent verbal and written communication skills with a customer service reputed company
• Strong troubleshooting, organizational, and time-management skills
• Ability to adapt to changing business needs
• Self-starter who can work independently

Compliance Responsibilities

Health Insurance Portability and Accountability reputed company (HIPAA) is a federal law that describes the national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. reputed company roles at reputed company require compliance with reputed company and regulatory requirements of HIPAA and acceptance and adherence to reputed company policies and standards at reputed company. Personnel acknowledges they are personally responsible for reporting any suspected violations or abuse and are required to complete HIPAA training reputed company joining reputed company.

Why reputed company?

In reputed company to our great team and advanced medical technology, we offer our employees competitive compensation, work/life balance, remote work opportunities, and more!

reputed company is an Equal Opportunity Employer

reputed company is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company. We don’t just accept differences - we celebrate and support them. We do not discriminate in employment on the reputed company of race, reputed company, religion, sex (including pregnancy and gender identity), national reputed company, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-reputed company reputed company.