Tech Stack

Description

You will oversee the prior authorization workflow for our clonoSEQ MRD Assay, mentor team members, and ensure timely insurance approvals. You'll act as a subject matter expert, handle complex cases, and drive process improvements to maintain compliance and efficiency.

Requirements

• High school diploma.
• 4+ years in prior authorization, medical billing, or insurance verification.
• Familiarity with molecular/genetic testing and payer guidelines.
• Leadership and communication skills.
• Proficiency in EMR systems and Microsoft Office Suite.
• Ability to analyze data and identify process improvements.
• Attention to detail and accuracy.
• Highly organized and effective communicator.
• Problem-solving and critical thinking.
• Ability to work in a fast-paced environment and manage multiple priorities.
• Preferred: Associate or bachelor’s degree.
• Preferred: Workgroup coordinator experience.
• Preferred: Experience with Careviso, Glidian and Quadax systems.

Responsibilities

• Mentor Prior Authorization Specialists, providing guidance on complex cases and payer requirements.
• Monitor daily workload and redistribute tasks to maintain efficiency and meet turnaround time goals.
• Serve as the primary escalation point for unresolved authorization issues.
• Develop and implement best practices for prior authorization workflows.
• Assist in tracking team performance metrics (e.g., approval rates, turnaround times) and report to management.
• Identify trends in denials and collaborate with reimbursement and billing teams to resolve systemic issues.
• Submit and manage prior authorization requests for molecular and genetic testing when needed.
• Review clinical documentation for compliance with payer policies.
• Communicate with insurance companies, providers, and patients regarding authorization status.
• Ensure all team activities comply with HIPAA and regulatory guidelines.
• Maintain accurate records and audit prior authorization files for quality assurance.
• Onboard new team members and provide ongoing training on payer policies and laboratory protocols.
• Keep the team informed of changes in insurance requirements and molecular testing coverage.
• All other duties as assigned.