Prior Authorization Specialist

🔥 20 hours ago

🇺🇸 United States – Remote

💵 $29 - $33 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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GeneDx

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🧬 Biotechnology

🏥 Healthcare

🤖 Artificial Intelligence

Biotechnology • Healthcare • Artificial Intelligence

GeneDx is a biotechnology company dedicated to providing personalized and targeted medical care through genetic diagnosis. Leveraging one of the largest datasets for rare diseases, GeneDx offers advanced testing such as whole genome and exome sequencing. Their diagnostic solutions translate complex genomic information into actionable insights, facilitating personalized health plans, enhancing drug discovery, and improving the efficiency of healthcare systems.

📋 Description

• Review and resolve prior authorization inquiries in Salesforce • Research accounts requiring appeals for prior authorization denials • Prepare and submit appeals to insurance companies with required medical records, documentation, and justification • Review and resolve rejected authorizations • Communicate with healthcare providers and insurance companies to facilitate peer-to-peer review • Submit and track prior authorization requests using appropriate systems and tools • Ensure documentation is complete and accurate to avoid authorization delays • Track appeal outcomes and follow up on unresolved cases • Collaborate with clinical teams, billing, market access, and insurance representatives • Provide management with regular updates on authorizations and appeals • Stay informed about insurance guidelines and payer requirements • Communicate with internal and external stakeholders • Perform additional duties as assigned

🎯 Requirements

• 3-5 years of experience in healthcare billing, with a focus on prior authorizations and appeals • Strong understanding of insurance policies, medical terminology, and coding • Knowledge of insurance authorization and verification processes for major health plans • Strong communication and interpersonal skills • Experience using Google Apps, Mac OS X, and CRM applications • Understanding of HIPAA regulations for healthcare • Xifin, SalesForce, and careviso experience is a plus • Ability to support EST hours • Exceptional attention to detail and organizational abilities • No certificates, licenses, or registrations required • High school diploma preferred

🏖️ Benefits

• Competitive compensation and benefits reflecting local market practices and legal requirements • Fully remote work from a home office or other suitable remote location • Flexible schedule and hours established in collaboration with the leader and adjusted to business needs • Reasonable accommodations for individuals with disabilities