[Hiring] Prior Authorization Specialist @GeneDx

Role Description

The Prior Authorization specialist will work closely with the Prior Authorization Manager who is responsible for all aspects of the prior and retro authorization process. This role also involves:

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

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

Job Responsibilities

• 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
• All job duties must be performed in a manner that demonstrates the company Leadership Attributes and support of the Mission & Values of the company
• Other duties may be assigned

Qualifications

• High school diploma preferred
• 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
• Be 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

Certificates, Licenses, Registrations

• None

Work Environment

This is a fully remote position. The employee will work from a home office or other suitable remote location with reliable high-speed internet access. Work is performed in a climate-controlled environment using standard office equipment including computer, phone, and video conferencing tools. Your standard work schedule and hours will be established in collaboration with your leader and may be adjusted to align with evolving business needs.

Physical Demands

• Sitting for extended periods (up to 8 hours per day)
• Repetitive use of hands and fingers for typing and mouse operation
• Visual acuity for reading computer screens and documents
• Ability to communicate effectively via phone and video calls
• Occasional lifting of up to 10 pounds (office supplies, equipment)
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position

Acknowledgements

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

Pay Transparency, Budgeted Range

$29.56 — $33.80 USD

Company Description

At GeneDx, we're driven by urgency and purpose: helping patients get diagnosed earlier. Our mission, to empower everyone to live their healthiest life through genomics, drives our team to make a tangible impact each day – and shapes our culture where high standards, strong teamwork, and meaningful ownership are the norm.

• We act with intention, support one another, and deliver work we're proud to put our names on
• We bring energy, focus, and a bias for action
• We push past the obvious and challenge assumptions
• We stay curious, ask questions, and share direct feedback with respect

If you’re motivated by meaningful work, a fast-moving environment, and teammates who care deeply about outcomes, you’ll thrive at GeneDx.

We welcome everyone regardless of their background. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, gender, gender identity, sexual orientation, protected veteran status, disability, age, and other characteristics protected by law.

GeneDx is a place where people from all backgrounds can make an impact.

All privacy policy information can be found here .