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Position Overview

The Senior Manager, Reimbursement Operations will lead the reimbursement operations team in managing all front-end and prior authorization processes, as well as other reimbursement operations functions such as insurance eligibility/discovery, client billing, post-claim follow-up and account outreach. This role will oversee and enhance workflows to maximize reimbursement, minimize denials, and streamline communication with both internal and external stakeholders. The Senior Manager will collaborate closely with cross-functional teams such as the Payor Relations team and play a pivotal role in refining and implementing strategic improvements within reimbursement operations. Successful candidates will demonstrate leadership skills, attention to detail, and the ability to drive outcomes in a dynamic healthcare environment.

Leaders at Adaptive demonstrate behaviors consistent with Adaptive’s Core Values and Leadership Principles. Critical functions of your role include helping establish individual team member goals, aligning those individual goals with broader team objectives, and ensuring those objectives drive the achievement of company goals. Providing thoughtful coaching and consistent feedback to your team members will drive performance excellence and accountability, as well as support your team members’ growth and development. Leaders at Adaptive create an environment of belonging, respect, and open and honest communication every day.

Key Responsibilities and Essential Functions

Lead and oversee the Prior Authorization, Eligibility, and Insurance Discovery teams, ensuring timely and accurate processing of authorizations. Ensure comprehensive insurance eligibility and benefit discovery processes for new and existing patients. Develop and implement strategies to improve prior authorization approval rates and reduce denials. Manage the account outreach team to ensure accurate and timely medical record collection for billing and reimbursement. Oversee client billing processes, ensuring compliance and accuracy in all billing activities. Develop and monitor processes for Letters of Agreement (LOAs) to align with reimbursement requirements. Manage appeals and claims follow-up processes, ensuring compliance with all regulatory standards and maximizing successful appeals. Collaborate with the analytics team to create reports and dashboards that track reimbursement and authorization metrics. Provide training, guidance, and coaching to team members to foster skill development and compliance with policies. Identify and implement process improvements to streamline reimbursement workflows and reduce administrative burden. Serve as point of contact for cross-functional teams in sales, clinical services, and finance for reimbursement operations-related queries. Collaborate with third-party vendors to optimize software and service solutions for reimbursement operations. Establish clear goals for the team, align them with organizational objectives, and monitor team performance. Participate in forecasting and budgeting processes in collaboration with finance and other operational teams. Ensure compliance with all federal, state, and local laws and regulations regarding billing and reimbursement practices.

Position Requirements (Education, Experience, Other)

Required

Bachelor’s degree, 12+ years of experience in healthcare reimbursement operations with at least 5 years in a management role preferred Minimum of 5 years of experience with billing and reimbursement in CLIA laboratory services sector, oncology industry preferred. Extensive experience with prior authorization, insurance eligibility, account outreach, billing, and appeals processes. Strong understanding of medical billing and coding, including knowledge of ICD-10, CPT codes, and payer guidelines. Experience managing and optimizing workflows and processes to improve reimbursement rates. Proven ability to lead and develop high-performing teams. Proficiency in data analysis, with a strong ability to derive insights from metrics to drive improvements. Strong written and verbal communication skills for effective interaction with stakeholders at all levels. Ability to work collaboratively in a cross-functional environment

#LI-Remote

Compensation

Salary Range: $127,400 - $191,200

Other compensation elements include:

equity grant bonus eligible

ALERT: Malicious groups posing as Adaptive employees have recently used fraudulent email aliases to extend employment offers, provide fake documents, and request sensitive personal and financial information. Legitimate Adaptive employment opportunities are initiated through our careers page and extended after multiple interviews with verified employees. Adaptive does not ask new hires to purchase anything out-of-pocket, including home office supplies and equipment. 

Interested in this position, but don’t meet all the requirements?  Adaptive is committed to building diverse, equitable, and inclusive teams across our organization.  Please consider applying even if your experience doesn’t match all the qualifications; you may be the exact candidate we’re searching for!

Adaptive is not currently sponsoring candidates requiring work authorization support for this position.

Adaptive’s posted compensation information includes a base salary (or hourly rate) range and summary of other available total compensation. The base salary range represents a minimum-to-maximum salary (or hourly rate) available to candidates upon extension of offer. Base salary is thoughtfully considered upon offer and is determined through multiple evaluation checks throughout the interview process, including: a candidate’s ability to meet minimum qualifications (skills/experience/education), a candidate’s ability to thoughtfully address preferred qualifications, current market conditions, and internal pay equity. Listed base salary is exclusive of bonus, commission, equity, differential pay, benefits, and other incentives.

Adaptive's benefits at-a-glance.

Adaptive Biotechnologies is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability. Please refer the Equal Employment Opportunity Posters for more information. If you’d like to view a copy of the company’s affirmative action plan or policy statement, please email hr@adaptivebiotech.com.

If you have a disability and you believe you need a reasonable accommodation to search for a job opening or to submit an online application, please e-mail accommodations@adaptivebiotech.com. This email is created exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only messages left for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response.

NOTE TO EMPLOYMENT AGENCIES: Adaptive Biotechnologies values our relationships with our Recruitment Partners and will only accept resumes from those partners who have active agreements with Adaptive. Adaptive Biotechnologies is not responsible for any fees related to resumes that are unsolicited or are received by any employee of Adaptive Biotechnologies who is not a member of the Human Resources team.