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.
• Support team members as subject matter expert in prior authorization and appeals process.
• 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 well-versed 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.
• Outstanding phone and email communication skills.
• Have high energy, be a self-starter, 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
• Experience using Google Apps, Mac OS X, and CRM applications (i.e., Salesforce), XiFin and careviso.