Description

You will manage insurance claim appeals for molecular and genetic testing services, preparing and submitting appeal documentation, following up with payers, and collaborating with internal teams to resolve claim denials efficiently.

Requirements

• 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

Responsibilities

• 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
• 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
• 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
• 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