Prior Authorization Specialist

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $21 - $23 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Adaptive Biotechnologies Corp.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2009

🏥 Healthcare

🧬 Biotechnology

⚕️ Healthcare Insurance

💰 $125M Post-IPO Debt on 2022-09

Healthcare • Biotechnology • Healthcare Insurance

Adaptive Biotechnologies Corp. is a leader in immune-driven medicine, aiming to revolutionize disease detection and treatment. By utilizing the adaptive immune system, the company develops diagnostic and therapeutic solutions powered by its innovative Immune Medicine platform. They offer clinical diagnostics, particularly in Minimal Residual Disease (MRD) testing, and engage in drug discovery and therapeutic development through adaptive immunosequencing technologies. Their biopharma services support the progression of clinical trials and the development of transformative medicines. Adaptive Biotechnologies leverages the complex biology of the immune system, decoding it to advance medical science and improve patient outcomes.

📋 Description

• Obtain insurance approvals for Adaptive Biotechnologies’ clonoSEQ MRD Assay • Submit and track prior authorization requests for clonoSEQ • Review clinical documentation for compliance with payer requirements • Communicate with insurance companies to resolve authorization issues • Maintain accurate authorization records in Adaptive’s RCM system • Ensure compliance with HIPAA and other regulatory guidelines • Stay updated on payer policies related to molecular and genetic testing • Identify and escalate denial or delay trends to management • Collaborate with billing and reimbursement teams on claims processing • Assist in developing best practices for prior authorization workflows • Perform other duties as assigned

🎯 Requirements

• 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 • Flexibility to work outside standard hours when necessary, including nights, weekends, and holidays • Not currently sponsoring candidates requiring work authorization support • Associate or bachelor’s degree preferred • Experience with Careviso, Glidian, and Quadax systems preferred • Experience in molecular or genetic testing preferred

🏖️ Benefits

• Equity grant • Bonus eligible • Affirmative Action and Equal Opportunity Employer • Reasonable accommodation support for disabled job seekers