[Hiring] Prior Authorization Specialist @Adaptive Biotechnologies

Role Description

The Prior Authorization Specialist is responsible for obtaining insurance approvals for Adaptive Biotechnologies clonoSEQ MRD Assay. This role ensures timely and accurate processing of prior authorizations to facilitate patient access to essential laboratory services. The specialist acts as a liaison between the laboratory, healthcare providers, and insurance companies to minimize delays and optimize reimbursement.

Key Responsibilities and Essential Functions

• Prior Authorization Management
  • Submit and track prior authorization requests for clonoSEQ.
  • Review clinical documentation to ensure compliance with payer requirements.
  • Communicate with insurance companies to resolve authorization issues promptly.
• Documentation & Compliance
  • Maintain accurate records of all authorization activities in Adaptive’s RCM system.
  • Ensure compliance with HIPAA and other regulatory guidelines.
• Insurance & Payer Coordination
  • Stay updated on payer policies related to molecular and genetic testing.
  • Identify and escalate trends in denials or delays to management for resolution.
• Workflow Optimization
  • Work closely with billing and reimbursement teams to ensure smooth claims processing.
  • Assist in developing best practices for prior authorization workflows.
• All other duties as assigned.

Qualifications

• High school diploma or equivalent.
• Minimum 2 years in prior authorization, medical billing, or insurance verification.
• Strong understanding of insurance processes and medical terminology.
• Excellent communication and organizational skills.
• Proficiency in EMR systems and Microsoft Office Suite.
• Attention to detail and accuracy.
• Ability to work independently and manage multiple priorities.
• Strong problem-solving and critical thinking skills.

Requirements

• Associate or bachelor’s degree (preferred).
• Experience with Careviso, Glidian, and Quadax systems (preferred).
• Experience in molecular or genetic testing is preferred.

Benefits

• Hourly Rate: $21.68 - $23.99.
• Other compensation elements include:
  • Equity grant.
  • Bonus eligible.