Appeals Specialist

Role: Appeals Specialist managing insurance claim appeals for molecular and genetic testing services to ensure reimbursement and payer compliance. Responsibilities include reviewing denied claims, preparing and submitting appeal documentation via payer-preferred formats, tracking appeal status, and collaborating with internal teams to resolve denials efficiently. The role also involves staying current on payer policies, ensuring regulatory compliance (HIPAA), and identifying denial trends. Requirements: High school diploma; 2+ years in insurance appeals, medical billing, or revenue cycle operations; strong understanding of insurance processes; excellent communication skills; proficiency in billing systems and MS Office; detail-oriented and organized. Preferred qualifications include an Associate’s or Bachelor’s degree and experience with molecular/genetic testing or specialty lab billing. Work conditions may require flexible hours, including nights, weekends, and holidays. Physical work is primarily desk-based. The position offers hourly compensation ($22.74-$27.79), with potential for equity and bonuses. The role is critical for revenue cycle success in a biopharma environment focused on molecular/genetic diagnostics within a regulatory and compliance framework, emphasizing collaboration with billing, prior authorization, and payer relations teams.