Reimbursement Specialist – Appeals

NAVERIS

Reimbursement Specialist managing denials and appeals in the reimbursement department of Naveris. Focus on claims management in the context of molecular diagnostics for viral-associated cancers.

Posted 7/11/2026full-timeRemote • Massachusetts, North Carolina • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in denials management and appeals processes, with a strong understanding of medical benefit structures and coding systems such as CPT, ICD-10, and HCPCS. Proven ability to analyze and resolve reimbursement issues while ensuring compliance with billing regulations.

Highest-signal resume keywords

Denials ManagementAppeals PreparationXifin ExperienceCPT Coding KnowledgeExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Reimbursement ManagementDenial AnalysisRoot Cause IdentificationClaims SubmissionEOB InterpretationPayer Guidelines ComplianceWorkflow DevelopmentDocumentation MaintenanceRevenue Cycle ManagementMedical Coding

Soft Skills

Attention to DetailJudgmentOrganizational SkillsTime ManagementCustomer Service Mindset

Tools & Technologies

XifinQuadaxTelcorPayer Portals

Industry Keywords

Billing RegulationsDenial TypesAppeals WorkflowsInsurance CommunicationPatient Interaction

About the role

Key responsibilities & impact

Support post-submission reimbursement activities
Focus on denials management and appeals
Investigate denials, prepare and submit appeals
Follow up with payers to ensure timely and accurate reimbursement
Manage various denial types and prepare higher-level appeals
Review and interpret Explanation of Benefits (EOBs)
Contact insurance companies and utilize payer portals
Submit corrected claims and appeals in accordance with payer guidelines
Maintain accurate documentation of denials and appeals actions
Assist in developing payer-specific appeals workflows
Communicate with patients and providers regarding appeals related questions
Critically assess challenging situations and escalate when appropriate
Ensure compliance with billing regulations and company policies

Requirements

What you’ll need

4+ years of experience in reimbursement, denials management, or revenue cycle management
Bachelor’s degree or equivalent experience
Experience with Xifin, Quadax, or Telcor preferred
Strong understanding of medical benefit structures
Working knowledge of CPT, ICD-10, and HCPCS coding
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

Benefits

Comp & perks

Competitive compensation
Work/life balance
Remote work opportunities