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[Hiring] Prior Authorization Specialist @GeneDx id-7644

Role Description

The Prior Authorization Specialist will work closely with the Prior Authorization Manager to manage all aspects of the prior and retro authorization process. This will include:

  • Responding to email inquiries
  • Filing appeals for denied prior authorizations
  • Ensuring timely resolution
  • Supporting reimbursement efforts as assigned

The ideal candidate will have a strong understanding of the prior authorization process, healthcare insurance billing, medical terminology, and appeals process.

Qualifications

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  • 3-5 years of experience in healthcare billing experience, with a focus on prior authorizations and appeals
  • Strong understanding of insurance policies, medical terminology, and coding
  • Well-versed in insurance authorization and verification process for major health plans
  • Strong communication and interpersonal skills, with the ability to work effectively in a team environment
  • Experience using Google Apps, Mac OS X, and CRM applications
  • Understanding of industry-specific policies, such as HIPAA regulations for health care
  • Xifin, SalesForce and careviso experience a plus
  • Can support EST hours
  • Exceptional attention to detail and organizational abilities

Requirements

  • Actively review and resolve Prior Authorization inquiries in SalesForce
  • Research accounts that require appeals for prior authorization denials
  • Prepare and submit appeals to insurance companies, including the compilation of necessary medical records, documentation, and justification
  • Review and resolve rejected authorizations
  • Communicate effectively with healthcare providers and insurance companies to facilitate peer to peer review
  • Submit and track prior authorization requests using appropriate systems and tools
  • Ensure all required documentation is complete and accurate to avoid delays in authorization
  • Track appeal outcomes and follow up on unresolved cases to ensure successful resolution
  • Collaborate closely with clinical teams, billing department, market access and insurance representatives to resolve authorization issues
  • Provide regular updates to management on the status of authorizations and appeals
  • Stay informed of changes in insurance guidelines and payer requirements
  • Communicate effectively with internal and external stakeholders
  • The job may have added responsibilities as assigned

Benefits

  • Paid Time Off (PTO)
  • Health, Dental, Vision and Life insurance
  • 401k Retirement Savings Plan
  • Employee Discounts
  • Voluntary benefits.
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