Prior Authorization Manager - San Diego, United States - GeneDx

GeneDx

Verified Company

San Diego, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

GeneDx is a patient-centric health information company that delivers personalized and actionable health insights that inform diagnosis, guide treatment and improve drug discovery. The company is transforming healthcare through its industry-leading exome and genome testing and interpretation, fueled by one of the world's largest, rare disease data sets. GeneDx is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable precision medicine as the standard of care.
We are seeking to add a Prior Authorization Manager to our team. The Prior Authorization Manager is responsible for all aspects of the prior and retro authorization process.

The individual will be expected to lead our partnership with our Prior Authorization vendor and work cross-functionally across many departments (sales, operations, billing, and lab teams) to serve our patient and client needs.

What you will do:

Maintain all COMPANY processes and policies up to date for the Prior Authorization workflow.
Lead Prior Authorization relationship with external Prior Authorization vendor.
Research payors prior authorization requirements to manage billing edits.
Ensure authorization requests are submitted within payor filing requirements.
Identify payor trends and suggest potential improvements.
Track Prior Authorization outcome and implement changes that lead to approvals.
Ensure insurance requests for additional clinical records are obtained in accordance with the payor requirements.
Collaborate with your team and to develop best practices to ensure we are providing the best service and experience to all customers.
Participate in projects that extend beyond your day to day to stretch you to think creatively.

Qualification:

Be wellversed in insurance authorization and verification process for major health plans.
Ability to monitor a high volume of prior authorization requests.
Exceptional attention to detail and organizational abilities.
Have high energy, be a selfstarter, great teammate and ready to roll up your sleeves to get things done.
Possess a strong work ethic and commitment to improving patients' lives.
Be flexible and adaptable with a drive to go above and beyond.
Can support PST or EST hours.
Bachelor's degree preferred
5+ years of healthcare billing experience

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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.

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_ _Benefits include**: