[Hiring] Prior Authorization Specialist @GeneDx ID-1005
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
- 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
