Reimbursement Specialist - Appeals

Naveris • Waltham, MA

11d • Remote

About The Position

Would you like to be part of a fast-growing team that believes no one should have to succumb to viral-mediated cancers? Naveris, a commercial stage, precision oncology diagnostics company with facilities in Boston, MA and Durham, NC, is looking for a Reimbursement Specialist - Appeals team member to help us advance our mission of developing and delivering novel diagnostics that transform cancer detection and improve patient outcomes. Our flagship test, NavDx, is a breakthrough blood-based DNA test for HPV cancers, clinically proven and already trusted by thousands of physicians and institutions across the U.S. Opportunity We are looking for a conscientious, detail-oriented Reimbursement Specialist – Appeals to join our team and support post-submission reimbursement activities. While Naveris partners with an outsourced RCM vendor, this role focuses on denials management and appeals to ensure accurate reimbursement across Medicare, Medicaid, and commercial insurance plans.

Requirements

• 4+ years of experience in reimbursement, denials management, or revenue cycle management within a diagnostics company, laboratory, or commercial payer environment
• Bachelor’s degree or equivalent experience
• Strong understanding of medical benefit structures, including Federal, State, PPO, HMO, and indemnity plans
• Working knowledge of CPT, ICD-10, and HCPCS coding, as well as LCD/NCD coverage and reimbursement guidelines
• Proven ability to analyze denials, identify root causes, and resolve issues effectively
• Strong attention to detail, judgment, and follow-through
• Excellent verbal and written communication skills with a customer service mindset
• Strong troubleshooting, organizational, and time-management skills
• Ability to adapt to changing business needs
• Self-starter who can work independently
• Compliance Responsibilities
• Health Insurance Portability and Accountability Act (HIPAA) is a federal law that describes the national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. All roles at Naveris require compliance with legal and regulatory requirements of HIPAA and acceptance and adherence to all policies and standards at Naveris. Personnel acknowledges they are personally responsible for reporting any suspected violations or abuse and are required to complete HIPAA training when joining the company.

Nice To Haves

• Experience with Xifin, Quadax, or Telcor preferred

Responsibilities

• Manage various denial types that may result in 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
• Assist in developing and maintaining payer-specific appeals workflows and documentation
• Communicate with patients and providers regarding appeals-related billing questions, EOBs, and financial responsibility in complex or escalated cases
• Critically assess challenging situations and escalate to the Supervisor or leadership when appropriate
• Maintain a strong understanding of the end-to-end reimbursement lifecycle and how appeals impact revenue outcomes
• Utilize systems, tools, and vendor resources to support appeals activities efficiently
• Prioritize multiple concurrent appeals and operate with a sense of urgency
• Ensure compliance with all applicable billing regulations and company policies, including HIPAA
• Comply with all Federal and State regulations related to billing and reimbursement

Benefits

• In addition to our great team and advanced medical technology, we offer our employees competitive compensation, work/life balance, remote work opportunities, and more!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 11-50 employees