Insurance Specialist
Core
Proactively manage delayed, denied, or underpaid insurance claims to ensure timely reimbursement for molecular and specialty testing services.
Role type
Insurance Specialist (Revenue Cycle Operations)
Builds
Revenue cycle performance and patient access for molecular/NGS testing
Domain
Healthcare / Insurance Billing / Molecular Diagnostics
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
insurance billing processes, denial code resolution, payer follow-up workflows, billing system proficiency, Microsoft Office Suite, root cause analysis, policy interpretation, HIPAA compliance, single-case agreement management
Preferred skills
molecular/genetic testing billing, specialty laboratory billing, Quadax or similar RCM systems
Responsibilities
Review and analyze delayed or denied claims to determine root cause based on EOB or remittance advice; Conduct timely follow up with insurance carriers to clarify claim status and secure payment; Obtain missing information, correct coding or billing errors, and submit corrected claims; Research and interpret payer coverage policies, contracts, and medical necessity requirements; Document all follow up activity and resolution steps accurately within the billing system; Track claim statuses, denial reasons, and resolution timelines to identify trends; Manage incoming single-case agreements or LOAs and negotiate appropriate reimbursement rates
Seniority
Mid-level, hands-on IC