Reimbursement Specialist - Appeals - Remote

1w1 week ago

Naveris

US · Full-time · $65,000 – $85,000

About this role

Naveris, a commercial-stage precision oncology diagnostics company, seeks a Reimbursement Specialist - Appeals to join our fast-growing team. We believe no one should succumb to viral-mediated cancers, and our flagship NavDx test transforms HPV cancer detection. Help deliver diagnostics trusted by thousands of physicians across the U.S.

This detail-oriented role supports post-submission reimbursement, focusing on denials management and appeals across Medicare, Medicaid, and commercial plans. Investigate denials, prepare appeals, and follow up with payers for timely reimbursement. Partner with our outsourced RCM vendor to ensure accurate payments.

Report to the Reimbursement Supervisor – Back End within the Reimbursement department. Utilize payer portals, systems, and vendor resources efficiently. Prioritize concurrent appeals with urgency while maintaining compliance.

Review EOBs to identify root causes and develop payer-specific workflows. Communicate with patients and providers on complex billing issues. Advance our mission to improve patient outcomes through effective appeals resolution.

Requirements

Experience in denials management and appeals resolution for Medicare, Medicaid, and commercial payers
Proficiency reviewing and interpreting EOBs and remittance advices
Knowledge of payer-specific guidelines, portals, and reimbursement timelines
Familiarity with medical billing processes in diagnostics or oncology
Ability to investigate denial root causes and prepare appeals documentation
Understanding of HIPAA and federal/state billing regulations
Skill in prioritizing multiple appeals with a sense of urgency
Experience using RCM systems and vendor resources for reimbursement activities

Responsibilities

Manage various denial types including 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
Communicate with patients and providers regarding appeals-related billing questions, EOBs, and financial responsibility in complex cases
Ensure compliance with all applicable billing regulations and company policies, including HIPAA