Prior Authorization & Laboratory Billing Specialist

Job Title: Prior Authorization & Laboratory Billing Specialist

Location: On-site - Tampa, FL
Employment Type: Full-Time
Department: Laboratory Revenue Cycle / Billing

Position Summary

We are seeking an experienced Prior Authorization & Laboratory Billing Specialist to support our clinical laboratory revenue cycle operations. This role focuses on obtaining prior authorizations, verifying insurance coverage, and ensuring accurate billing for laboratory testing services. The ideal candidate understands laboratory billing requirements, payer-specific authorization rules, and documentation standards necessary to support compliant and timely reimbursement.

Key Responsibilities

• Obtain and track prior authorizations for clinical and diagnostic laboratory testing
• Verify patient insurance eligibility, benefits, and medical necessity requirements
• Review test orders for completeness, coverage criteria, and payer-specific authorization needs
• Communicate with payers regarding authorization requirements, claim status, denials, and appeals
• Ensure accurate documentation of authorization reference numbers and payer communications
• Submit and review laboratory claims for accuracy and compliance
• Assist with denial management, appeals, and payer audits related to laboratory testing
• Work closely with accessioning, client services, and billing teams to prevent claim delays
• Maintain compliance with CLIA, payer policies, and laboratory billing regulations
• Stay current on changes in payer rules, LCDs/NCDs, and laboratory billing guidelines

Qualifications

• High school diploma or equivalent required; associate’s degree preferred
• Minimum [1–3] years of experience in laboratory billing, prior authorization, or revenue cycle operations
• Working knowledge of CPT, ICD-10, and HCPCS codes related to laboratory testing
• Experience with Medicare, Medicaid, and commercial payer authorization requirements
• Familiarity with laboratory information systems (LIS), EHRs, and billing software
• Strong attention to detail and documentation accuracy
• Excellent communication and follow-up skills
• Ability to manage high-volume workflows in a fast-paced laboratory environment

Preferred Experience

• Clinical or reference laboratory billing experience
• Toxicology, molecular, or specialty testing authorization experience
• Knowledge of medical necessity documentation, ABNs, and payer audit processes
• Denial appeals and reimbursement optimization experience

What We Offer

• Competitive compensation based on experience
• Benefits package including [health insurance, PTO, holidays, retirement options]
• Stable, compliance-focused laboratory environment