Prior Authorization Specialist

GeneDx (Nasdaq: WGS) delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The company is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable precision medicine as the standard of care. GeneDx is at the forefront of transforming healthcare through its industry-leading exome and genome testing and interpretation services, fueled by the world’s largest, rare disease data sets. For more information, please visit www.genedx.com.  

We are seeking a add a Prior Authorization Specialist to our team. The Prior Authorization specialist will work closely with the Prior Authorization Manager who is responsible for all aspects of the prior and retro authorization process. This role also involves responding to email inquiries, filing appeals for denied prior authorizations, ensuring timely resolution, and supporting reimbursement efforts. The ideal candidate will have a strong understanding of the prior authorization process, healthcare insurance billing, medical terminology, and appeals process.

Job Responsibilities

• Actively review and resolve Prior Authorization inquires in SalesForce
• Research accounts that require appeals for prior authorization denials
• Prepare and submit appeals to insurance companies, including the compilation of necessary medical records, documentation, and justification.
• Review and resolve rejected authorizations.
• Communicate effectively with healthcare providers and insurance companies to facilitate peer to peer review.
• Submit and track prior authorization requests using appropriate systems and tools.
• Ensure all required documentation is complete and accurate to avoid delays in authorization.
• Track appeal outcomes and follow up on unresolved cases to ensure successful resolution.
• Collaborate closely with clinical teams, billing department, market access and insurance representatives to resolve authorization issues.
• Provide regular updates to management on the status of authorizations and appeals.
• Stay informed of changes in insurance guidelines and payer requirements.
• Communicate effectively with internal and external stakeholders.
• The job may have added responsibilities as assigned. All job duties must be performed in a manner that demonstrates the company Leadership Attributes and support of the Mission & Values of the company.

Ideal Candidate

• 3-5 years of experience in healthcare billing experience, with a focus on prior authorizations and appeals.
• Strong understanding of insurance policies, medical terminology, and coding.
• Be well-versed in insurance authorization and verification process for major health plans.
• Strong communication and interpersonal skills, with the ability to work effectively in a team environment.
• Experience using Google Apps, Mac OS X, and CRM applications.
• Understanding of industry-specific policies, such as HIPAA regulations for health care.
• Xifin, SalesForce and careviso experience a plus
• Can support EST hours.
• Exceptional attention to detail and organizational abilities.

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Science - Minded, Patient - Focused. 

At GeneDx, we create, follow, and are informed by cutting-edge science. With over 20 years of expertise in diagnosing rare disorders and diseases, and pioneering work in the identification of new disease-causing genes, our commitment to genetic disease detection, discovery, and diagnosis is based on sound science and is focused on enhancing patient care.

Experts in what matters most. 

With hundreds of genetic counselors, MD/PhD scientists, and clinical and molecular genomics specialists on staff, we are the industry’s genetic testing experts and proud of it. We share the same goal as healthcare providers, patients, and families: to provide clear, accurate, and meaningful answers we all can trust.

SEQUENCING HAS THE POWER TO SOLVE DIAGNOSTIC CHALLENGES.

From sequencing to reporting and beyond, our technical and clinical experts are providing guidance every step of the way:

TECHNICAL EXPERTISE

• High-quality testing: Our laboratory is CLIA certified and CAP accredited and most of our tests are also New York State approved.
• Advanced detection: By interrogating genes for complex variants, we can identify the underlying causes of conditions that may otherwise be missed.

CLINICAL EXPERTISE

• Thorough analysis: We classify variants according to our custom adaptation of the most recent guidelines. We then leverage our rich internal database for additional interpretation evidence.
• Customized care: Our experts review all test results and write reports in a clear, concise, and personalized way. We also include information for research studies in specific clinical situations.
• Impactful discovery: Our researchers continue working to find answers even after testing is complete. Through both internal research efforts and global collaborations, we have identified and published hundreds of new disease-gene relationships and developed novel tools for genomic data analysis. These efforts ultimately deliver more diagnostic findings to individuals.

Learn more About Us here.

Our Culture

At GeneDx, we are dedicated to cultivating an environment where creativity and innovation thrive. We believe in the power of community and collaboration, where diverse perspectives are embraced, and every voice contributes to our shared success. Our team is a vibrant mix of professionals who challenge and support each other in equal measure, fostering growth both personally and professionally. When you join us, you're not just taking on a job—you're joining a movement. A movement that champions curiosity, embraces change, and believes in making an impact, one patient at a time. Cultural principles we live by:  

• Be bold in our vision & brave in our execution. 
• Communicate directly, with empathy. 
• Do what we say we're going to do.  
• Be adaptable to change.  
• Operate with a bias for action.    

Benefits include:

• Paid Time Off (PTO)
• Health, Dental, Vision and Life insurance
• 401k Retirement Savings Plan
• Employee Discounts
• Voluntary benefits

GeneDx is an Equal Opportunity Employer.

All privacy policy information can be found here.