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Prior Authorization Specialist
@GeneDx
[Hiring] Prior Authorization Specialist @GeneDx
Mar 26, 2025 - GeneDx is hiring a remote Prior Authorization Specialist. đź’¸ Salary: $65,000 - $70,000 usd. đź“ŤLocation: USA.
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
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, but is not limited to:
- 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
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| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
Back to Remote jobs >
Customer Service
Customer Service
|
Salary
đź’¸
$65,000 - $70,000 usd
|
Remote
Location
USA
|
|
Job Type
full-time
|
Posted
Mar 26, 2025
|
️
| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
