Prior Authorization Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Secure insurance approvals for Adaptive Biotechnologies’ clonoSEQ MRD Assay

• Submit and monitor prior authorization requests for clonoSEQ

• Evaluate clinical documentation to ensure compliance with payer requirements

• Liaise with insurance companies to address authorization challenges

• Maintain precise authorization records in Adaptive’s RCM system

• Ensure adherence to HIPAA and other regulatory standards

• Stay informed about payer policies regarding molecular and genetic testing

• Identify and report trends related to denials or delays to management

• Collaborate with billing and reimbursement teams on processing claims

• Assist in establishing best practices for prior authorization workflows

• Perform additional duties as assigned

⛳️ Requirements

• High school diploma or equivalent

• At least 2 years of experience in prior authorization, medical billing, or insurance verification

• Strong knowledge of insurance processes and medical terminology

• Exceptional communication and organizational abilities

• Proficiency in EMR systems and Microsoft Office Suite

• Keen attention to detail and accuracy

• Capability to work independently and manage multiple priorities

• Strong problem-solving and critical thinking abilities

• Willingness to work outside of 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