Senior Payer Relations Specialist - Remote (WFH)

At Adaptive, we’re Powering the Age of Immune Medicine.  Our goal is to harness the power of the adaptive immune system to transform the way diseases are diagnosed and treated.

As an Adapter, you’ll have the opportunity to make a difference in people’s lives. With Adaptive, you’ll create a career highlight through collaboration with bright, curious colleagues working at the apex of innovation and application.

It’s time for your next chapter. Discover your story with Adaptive.

Position Overview

The Senior Payor Relations Specialist will focus on increasing collections from insurance companies by effectively managing payor follow-up and appeals of denied claims. This position will analyze and resolve payor reimbursement issues through in-depth research and analysis of claim data, payor policies, regulations, and coverage criteria.

This position will work in collaboration with the Market Access team, other cross-functional partners and Adaptive’s revenue cycle providers to develop and implement strategies for achieving maximal reimbursement and cash recovery from commercial payors. This role will help manage the operational and administrative processes for coding, billing, and payor follow-up - including overseeing appeals, development requests, and payor projects.

Key Responsibilities and Essential Functions

• 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.

Position Requirements (Education, Experience, Other)

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'

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Compensation

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

Other compensation elements include:

• equity grant
• bonus eligible

Interested in this position, but don’t meet all the requirements?  Adaptive is committed to building diverse, equitable, and inclusive teams across our organization.  Please consider applying even if your experience doesn’t match all the qualifications; you may be the exact candidate we’re searching for!

Adaptive is not currently sponsoring candidates requiring work authorization support for this position.

Adaptive’s posted compensation information includes a base salary (or hourly rate) range and summary of other available total compensation. The base salary range represents a minimum-to-maximum salary (or hourly rate) available to candidates upon extension of offer. Base salary is thoughtfully considered upon offer and is determined through multiple evaluation checks throughout the interview process, including: a candidate’s ability to meet minimum qualifications (skills/experience/education), a candidate’s ability to thoughtfully address preferred qualifications, current market conditions, and internal pay equity. Listed base salary is exclusive of bonus, commission, equity, differential pay, benefits, and other incentives.

Adaptive's benefits at-a-glance.

Adaptive Biotechnologies is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability. Please refer the Equal Employment Opportunity Posters for more information. If you’d like to view a copy of the company’s affirmative action plan or policy statement, please email hr@adaptivebiotech.com.

If you have a disability and you believe you need a reasonable accommodation to search for a job opening or to submit an online application, please e-mail accommodations@adaptivebiotech.com. This email is created exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only messages left for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response.

NOTE TO EMPLOYMENT AGENCIES: Adaptive Biotechnologies values our relationships with our Recruitment Partners and will only accept resumes from those partners who have active agreements with Adaptive. Adaptive Biotechnologies is not responsible for any fees related to resumes that are unsolicited or are received by any employee of Adaptive Biotechnologies who is not a member of the Human Resources team.