Support patients by ensuring timely prior authorizations and appeals for critical healthcare services. GeneDx is hiring a Prior Authorization Specialist to drive accurate, compliant, and efficient resolution of insurance authorization requests.
About GeneDx
GeneDx (Nasdaq: WGS) is at the forefront of precision medicine, delivering actionable health insights through exome and genome testing. Backed by the world’s largest rare disease dataset, GeneDx empowers patients, providers, and researchers with clear answers that guide diagnosis, treatment, and discovery. With 20+ years of innovation, GeneDx is transforming healthcare into a genome-guided future.
Schedule
- Full-time, remote position (#LI-REMOTE)
- Must be able to support EST hours
Responsibilities
- Review and resolve prior authorization inquiries in Salesforce
- Research and file appeals for denied authorizations, including compiling medical records and justifications
- Submit and track prior authorization requests, ensuring all documentation is complete and accurate
- Review and resolve rejected authorizations to prevent delays in patient care
- Communicate with healthcare providers and insurers to facilitate peer-to-peer reviews
- Track outcomes of appeals and follow up on unresolved cases
- Stay current on payer policies, insurance guidelines, and regulatory requirements
- Provide regular updates to management on the status of authorizations and appeals
- Collaborate with clinical, billing, and insurance representatives to ensure timely resolutions
Requirements
- 3–5 years of healthcare billing experience, focused on prior authorizations and appeals
- Strong knowledge of insurance policies, medical terminology, and coding
- Hands-on experience with authorization and verification processes for major health plans
- Familiarity with HIPAA regulations
- Exceptional organizational skills and attention to detail
- Strong interpersonal and communication abilities, comfortable working across teams
- Experience with Salesforce, Xifin, or Careviso a plus
- Proficiency with Google Apps and CRM platforms
- Ability to work independently in a fast-paced environment
Compensation & Benefits
- Salary range: $65,000 – $70,000 USD
- Paid Time Off (PTO)
- Health, dental, vision, and life insurance
- 401(k) retirement savings plan
- Employee discounts and voluntary benefits
At GeneDx, you’ll help improve access to genetic testing and play a direct role in advancing patient care.
Happy Hunting,
~Two Chicks…