Prior Authorization Specialist
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Job Description
Prior Authorization Specialist supporting appeals, authorizations, and reimbursement for GeneDx’s genomic testing services. Resolving insurance issues and coordinating with healthcare, billing, and clinical teams.
Responsibilities:
- Review and resolve prior authorization inquiries in Salesforce
- Research accounts requiring appeals for prior authorization denials
- Prepare and submit appeals to insurance companies with required medical records, documentation, and justification
- Review and resolve rejected authorizations
- Communicate with healthcare providers and insurance companies to facilitate peer-to-peer review
- Submit and track prior authorization requests using appropriate systems and tools
- Ensure documentation is complete and accurate to avoid authorization delays
- Track appeal outcomes and follow up on unresolved cases
- Collaborate with clinical teams, billing, market access, and insurance representatives
- Provide management with regular updates on authorizations and appeals
- Stay informed about insurance guidelines and payer requirements
- Communicate with internal and external stakeholders
- Perform additional duties as assigned
Requirements:
- 3-5 years of experience in healthcare billing, with a focus on prior authorizations and appeals
- Strong understanding of insurance policies, medical terminology, and coding
- Knowledge of insurance authorization and verification processes for major health plans
- Strong communication and interpersonal skills
- Experience using Google Apps, Mac OS X, and CRM applications
- Understanding of HIPAA regulations for healthcare
- Xifin, SalesForce, and careviso experience is a plus
- Ability to support EST hours
- Exceptional attention to detail and organizational abilities
- No certificates, licenses, or registrations required
- High school diploma preferred
Benefits:
- Competitive compensation and benefits reflecting local market practices and legal requirements
- Fully remote work from a home office or other suitable remote location
- Flexible schedule and hours established in collaboration with the leader and adjusted to business needs
- Reasonable accommodations for individuals with disabilities
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