[Hiring] Appeals Specialist @Adaptive Biotechnologies

Role Description

The Appeals Specialist is responsible for managing insurance claim appeals to ensure proper reimbursement for molecular and genetic testing services. This role involves preparing and submitting appeal documentation, following up with payer’s post-submission, and collaborating with internal teams to resolve claim denials efficiently. The specialist serves as a key contributor to revenue cycle success and payer compliance.

Key Responsibilities and Essential Functions

• Appeal Submission
  • Review denied claims and determine appropriate appeal strategy based on payer guidelines.
  • Prepare and submit appeal letters with supporting documentation (payer forms, medical records, prior authorization details, clinical justification).
  • Ensure appeals are submitted via the payers’ preferred format (portal, fax, mail) within payer-specific timelines to avoid missed opportunities.
• Post-Submission Follow-Up
  • Track appeal status and maintain accurate records in the billing system.
  • Contact insurance companies to confirm receipt and progress of appeals.
  • Escalate unresolved appeals or complex cases to management as needed.
• Research & Compliance
  • Stay current on payer policies and appeal requirements for molecular and genetic testing.
  • Ensure all appeal activities comply with HIPAA and regulatory standards.
  • Identify trends in denials and collaborate with reimbursement teams to reduce future occurrences.
• Collaboration & Communication
  • Work closely with prior authorization, billing, and payer relations teams to gather necessary documentation.
  • Communicate with providers when additional clinical information is required for successful appeal.
• All other duties as assigned.

Qualifications

• High school diploma required.
• 2 years in insurance appeals, medical billing, or revenue cycle operations.
• Strong understanding of insurance processes and denial management.
• Excellent written and verbal communication skills.
• Proficiency in billing systems and Microsoft Office Suite.
• Detail-oriented and organized.
• Ability to work independently and manage multiple priorities.
• Strong problem-solving and critical thinking skills.

Requirements

• Associate’s or Bachelor’s degree (preferred).
• Experience with molecular/genetic testing or specialty lab billing (preferred).

Working Conditions

• Flexibility to work out of standard hours when necessary, including nights & weekends, holidays, etc.

Physical Requirements

• This job is primarily completing work from a desk.

Compensation

• Hourly Rate: $22.74 - $27.79
• Other compensation elements include:
  • equity grant
  • bonus eligible

ALERT

Malicious groups posing as Adaptive employees have recently used fraudulent email aliases to extend employment offers, provide fake documents, and request sensitive personal and financial information. Legitimate Adaptive employment opportunities are initiated through our careers page and extended after multiple interviews with verified employees. Adaptive does not ask new hires to purchase anything out-of-pocket, including home office supplies and equipment.

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.

Company Description

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 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.

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 [email protected]. 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.

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.