Insurance Specialist

Position Overview

The Insurance Specialist is responsible for proactively managing delayed, denied, or underpaid insurance claims to ensure timely and accurate reimbursement. This role focuses on identifying root causes of claim issues, performing payer follow up, submitting corrected claims, and preventing unnecessary appeals. The specialist works collaboratively with billing, reimbursement, prior authorization, and client services teams to optimize revenue cycle performance, reduce denial rates, and support patient access for molecular and specialty testing services.

Key Responsibilities and Essential Functions

Claims Follow Up & Denial Resolution

• Review and analyze delayed or denied claims to determine root cause based on payer explanation of benefits (EOB) or remittance advice.
• Conduct timely follow up with insurance carriers to clarify claim status, resolve issues, and secure payment.
• Obtain missing information, correct coding or billing errors, and submit corrected claims or resubmissions when appropriate.
• Escalate unresolved or complex claims to Appeal Specialists or management as needed.

Research & Policy Review

• Research and interpret payer coverage policies, contracts, and medical necessity requirements related to molecular and NGS testing.
• Stay current on payer-specific guidelines to ensure accurate claim resolution and resubmission.

Documentation & Compliance

• Document all follow up activity, payer communication, and resolution steps accurately and timely within the billing system.
• Ensure all work complies with HIPAA, payer rules, and internal company policies.

Collaboration & Communication

• Partner closely with prior authorization, billing, reimbursement, and client services teams to gather required demographic, coding, or clinical documentation.
• Communicate with providers and internal stakeholders to resolve claim discrepancies or obtain additional information.

Reporting & Process Improvement

• Track claim statuses, denial reasons, resolution timelines, and follow up outcomes.
• Identify denial and delay trends and collaborate with leadership to implement strategies to reduce future denials.
• Provide feedback on workflow opportunities and process improvements to enhance revenue cycle efficiency.

Single Case Agreements

• Manage incoming single-case agreements or LOAs and negotiate appropriate reimbursement rates.
• Provide trends of single case agreements to contracting and payer relations teams.

All other duties as assigned.

Position Requirements (Education, Experience, Other)

Required

• High school diploma.
• 2 years of experience in insurance follow up, denial management, medical billing, or revenue cycle operations.
• Strong knowledge of insurance billing processes, denial codes, and payer follow up workflows.
• Excellent verbal and written communication skills.
• Strong problem solving and analytical abilities.
• Proficiency with billing systems and Microsoft Office Suite.
• Detail oriented with strong organizational skills.
• Ability to manage multiple priorities independently in a fast-paced environment.
• Critical thinker with a proactive approach to issue resolution.

Preferred

• Associate or bachelor’s degree preferred.
• Experience with molecular/genetic testing or specialty laboratory billing.
• Experience using Quadax or similar RCM systems.

Working Conditions

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

Physical Requirements

This job is primarily completing work from a desk.

#LI-Remote

Compensation

Hourly Rate: $22.74 - $27.79

Other compensation elements include:

• equity grant
• bonus eligible