Appeals Specialist

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.

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Position Overview

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.

Position Requirements (Education, Experience, Other)

Required

• High school diploma required.
• 2 years in insurance appeals, medical billing, or revenue cycle operations.