Role Description
The Sr Prior Authorization Specialist assists in overseeing the prior authorization workflow and vendors to ensure timely and accurate insurance approvals for Adaptive Biotechnologies clonoSEQ MRD Assay. This role combines hands-on prior authorization responsibilities, including workflow management, staff support, and process improvement initiatives. The position acts as a subject matter expert and liaison between the laboratory, vendors, payers, and internal reimbursement operations.
Key Responsibilities and Essential Functions
• Workflow Oversight
• 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.
• Operational Excellence
• 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.
• Prior Authorization Duties
• 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.
• Compliance & Documentation
• Ensure all team activities comply with HIPAA and regulatory guidelines.
• Maintain accurate records and audit prior authorization files for quality assurance.
• Training & Development
• 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.
Qualifications
• High school diploma.
• 4+ years in prior authorization, medical billing, or insurance verification.
• Familiarity with molecular/genetic testing and payer guidelines.
• Experience with Careviso, Glidian and Quadax systems is preferred but not required.
• 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.
Requirements
• Associate or bachelor’s degree (preferred).
• Workgroup coordinator experience (preferred).
Benefits
• Hourly Rate: $22.74 - $27.79
• Other compensation elements include:
• Equity grant
• Bonus eligible
Company Description
Adaptive Biotechnologies is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.
Apply tot his job
Apply To this Job