Insurance Specialist

<div class="content-intro"><p><strong>At Adaptive, we’re Powering the Age of Immune Medicine. </strong>Our goal is to harness the power of the adaptive immune system to transform the way diseases are diagnosed and treated.</p> <p>As an Adapter, you’ll have the opportunity to make a difference in people’s lives. With Adaptive, you’ll create a <span style="text-decoration: underline;">career highlight</span> through collaboration with bright, curious colleagues working at the apex of innovation and application.</p> <p>It’s time for your next chapter. Discover your story with Adaptive.<br><br></p></div><p><strong>Position Overview</strong></p> <p>The Insurance Specialist is responsible for proactively managing delayed, denied, or underpaid insurance claims to ensure timely and accurate reimbursement. This role focuses on identifying root causes of claim issues, performing payer follow up, submitting corrected claims, and preventing unnecessary appeals. The specialist works collaboratively with billing, reimbursement, prior authorization, and client services teams to optimize revenue cycle performance, reduce denial rates, and support patient access for molecular and specialty testing services.</p> <p><strong>Key Responsibilities and Essential Functions</strong></p> <p>Claims Follow Up & Denial Resolution</p> <ul> <li>Review and analyze delayed or denied claims to determine root cause based on payer explanation of benefits (EOB) or remittance advice.</li> <li>Conduct timely follow up with insurance carriers to clarify claim status, resolve issues, and secure payment.</li> <li>Obtain missing information, correct coding or billing errors, and submit corrected claims or resubmissions when appropriate.</li> <li>Escalate unresolved or complex claims to Appeal Specialists or management as needed.</li> </ul> <p>Research & Policy Review</p> <ul> <li>Research and interpret payer coverage policies, contracts, and medical necessity requirements related to molecular and NGS testing.</li> <li>Stay current on payer-specific guidelines to ensure accurate claim resolution and resubmission.</li> </ul> <p>Documentation & Compliance</p> <ul> <li>Document all follow up activity, payer communication, and resolution steps accurately and timely within the billing system.</li> <li>Ensure all work complies with HIPAA, payer rules, and internal company policies.</li> </ul> <p>Collaboration & Communication</p> <ul> <li>Partner closely with prior authorization, billing, reimbursement, and client services teams to gather required demographic, coding, or clinical documentation.</li> <li>Communicate with providers and internal stakeholders to resolve claim discrepancies or obtain additional information.</li> </ul> <p>Reporting & Process Improvement</p> <ul> <li>Track claim statuses, denial reasons, resolution timelines, and follow up outcomes.</li> <li>Identify denial and delay trends and collaborate with leadership to implement strategies to reduce future denials.</li> <li>Provide feedback on workflow opportunities and process improvements to enhance revenue cycle efficiency.</li> </ul> <p>Single Case Agreements</p> <ul> <li>Manage incoming single-case agreements or LOAs and negotiate appropriate reimbursement rates.</li> <li>Provide trends of single case agreements to contracting and payer relations teams.</li> </ul> <p>All other duties as assigned.</p> <p><strong>Position Requirements (Education, Experience, Other)</strong></p> <p>R