Prior Authorization Specialist

Position Overview

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 the 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

Position Requirements (Education, Experience, Other)

Required

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.

Preferred

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

Working Conditions

Flexibility to work out of standard hours when necessary, including nights & weekends, holiday etc.

Physical Requirements

This job is primarily completing work from a desk.