[Hiring] Prior Authorization Specialist REMOTE USA
Position: Prior Authorization Specialist
Date Posted: October 21, 2025
Industry: Healthcare / Genomics / Medical Services
Employment Type: Full Time
Experience: 3–5 years in healthcare billing with focus on prior authorizations and appeals
Qualification: Estimated qualification like Bachelor Degree holder, Diploma/Degree/Certificate
Salary: $65,000—$70,000 USD
Location: United States, REMOTE
Company: GeneDx
Description:
GeneDx is seeking a dedicated Prior Authorization Specialist to manage all aspects of prior and retro authorization processes. You will work closely with the Prior Authorization Manager to handle insurance inquiries, file appeals for denied authorizations, ensure timely resolution, and support reimbursement efforts.
Key Responsibilities:
- Review and resolve prior authorization inquiries using SalesForce.
- Research accounts requiring appeals for denied authorizations.
- Prepare and submit appeals to insurance companies with complete medical records and supporting documentation.
- Resolve rejected authorizations and facilitate peer-to-peer reviews with healthcare providers and insurers.
- Track prior authorization requests and ensure documentation completeness to avoid delays.
- Follow up on unresolved appeals and track outcomes to guarantee resolution.
- Collaborate with clinical teams, billing departments, market access, and insurance representatives.
- Provide regular status updates to management and stay informed on insurance guideline changes.
- Perform additional duties as assigned while embodying company Leadership Attributes and supporting the Mission & Values of GeneDx.
Ideal Candidate:
- Strong background in healthcare billing, prior authorizations, and appeals.
- Solid understanding of insurance policies, medical terminology, and coding.
- Knowledge of authorization and verification processes for major health plans.
- Excellent communication, teamwork, and interpersonal skills.
- Experience with Google Apps, Mac OS X, and CRM applications; familiarity with Xifin, SalesForce, and Careviso is a plus.
- Ability to support EST hours.
- Exceptional attention to detail and organizational skills.
About GeneDx:
GeneDx is a leader in genomic and clinical data interpretation, offering advanced exome and genome testing to improve patient care. With over 20 years of experience in rare disease diagnosis, our team includes genetic counselors, MD/PhD scientists, and genomics specialists dedicated to accurate, actionable results.
Culture & Values:
- Bold vision and brave execution.
- Direct communication with empathy.
- Accountability and follow-through.
- Adaptability and bias for action.
- Collaboration and innovation in a supportive environment.
Benefits:
- Paid Time Off (PTO)
- Health, Dental, Vision, and Life Insurance
- 401k Retirement Savings Plan
- Employee Discounts and Voluntary Benefits
GeneDx is an Equal Opportunity Employer.
Disclaimer: The job details above are structured for clarity and based on publicly available content from recruiters/Company pages. All rights remain with the original source; names may be withheld for confidentiality. We are not involved in the hiring process.
