Reimbursement Specialist Appeals

Waltham, MA - USA

Monthly Salary: Not Disclosed

Posted on: 5 hours ago

Vacancies: 1 Vacancy

Job Summary

About Us

Would you like to be part of a fast-growing team that believes no one should have to succumb to viral-mediated cancers Naveris a commercial 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 transform cancer detection and improve patient outcomes. Our flagship test NavDx is a breakthrough 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 our team and support post-submission reimbursement activities. While Naveris partners with an outsourced RCM vendor this role focuses on denials management and appeals to ensure accurate reimbursement across Medicare Medicaid and commercial insurance plans.

Job Responsibilities

Reporting to the Reimbursement Supervisor Back End this role supports the Reimbursement department with a focus on claims denials underpayments and appeals resolution. This position is responsible for investigating denials preparing and submitting appeals and following up with payers to ensure timely 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 when required
Review and interpret Explanation of Benefits (EOBs) to determine contractual allowances and identify root causes of denials
Contact insurance companies and utilize payer portals to investigate denials determine next steps and perform 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-related billing questions EOBs and financial responsibility in complex or escalated cases
Critically assess challenging situations and escalate to the Supervisor or leadership when appropriate
Maintain a strong understanding of the end-to-end reimbursement lifecycle and how appeals impact revenue outcomes
Utilize systems tools and vendor resources to support appeals activities efficiently
Prioritize multiple concurrent appeals and operate with a sense of urgency
Ensure compliance with all applicable billing regulations and company policies including HIPAA
Comply with all Federal and State regulations related to billing and reimbursement
Fully remote role (U.S.-based) with occasional travel for trainings meetings or on-site presence at headquarters.
Travel requirement: up to 5%.

Requirements

4 years of experience in reimbursement denials management or revenue cycle management within a diagnostics company laboratory or commercial payer environment
Bachelors degree or equivalent experience
Experience with Xifin Quadax 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 well as LCD/NCD coverage and reimbursement guidelines
Proven ability to analyze denials identify root causes and resolve issues effectively
Strong attention to detail judgment and follow-through
Excellent verbal and written communication skills with a customer service mindset
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 Act (HIPAA) is a federal law that describes the national standards to protect sensitive patient health information from being disclosed without the patients consent or knowledge. All roles at Naveris require compliance with legal and regulatory requirements of HIPAA and acceptance and adherence to all policies and standards at Naveris. Personnel acknowledges they are personally responsible for reporting any suspected violations or abuse and are required to complete HIPAA training when joining the company.

Why Naveris

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

Naveris is an Equal Opportunity Employer

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

Required Experience:

Manager