Prior Authorization Specialist
At Adaptive, we’re Powering the Age of Immune Medicine. Our goal is to harness the power of the adaptive immune system to transform the way diseases are diagnosed and treated.
As an Adapter, you’ll have the opportunity to make a difference in people’s lives. With Adaptive, you’ll create a career highlight through collaboration with bright, curious colleagues working at the apex of innovation and application.
It’s time for your next chapter. Discover your story with Adaptive.
Position Overview
The Prior Authorization Specialist is responsible for obtaining insurance approvals for Adaptive Biotechnologies clonoSEQ MRD Assay. This role ensures timely and accurate processing of prior authorizations to facilitate patient access to essential laboratory services. The specialist acts as a liaison between the laboratory, healthcare providers, and insurance companies to minimize delays and optimize reimbursement.
Key Responsibilities and Essential Functions
Prior Authorization Management
- Submit and track prior authorization requests for clonoSEQ
- Review clinical documentation to ensure compliance with payer requirements.
- Communicate with insurance companies to resolve authorization issues promptly.
Documentation & Compliance
- Maintain accurate records of all authorization activities in the Adaptive’s RCM system.
- Ensure compliance with HIPAA and other regulatory guidelines.
Insurance & Payer Coordination
- Stay updated on payer policies related to molecular and genetic testing.
- Identify and escalate trends in denials or delays to management for resolution.
Workflow Optimization
- Work closely with billing and reimbursement teams to ensure smooth claims processing.
- Assist in developing best practices for prior authorization workflows.
All other duties as assigned
Position Requirements (Education, Experience, Other)
Required
- High school diploma or equivalent.
- Minimum 2 years in prior authorization, medical billing, or insurance verification.
- Strong understanding of insurance processes and medical terminology.
- Excellent communication and organizational skills.
- Proficiency in EMR systems and Microsoft Office Suite.
- Attention to detail and accuracy.
- Ability to work independently and manage multiple priorities.
- Strong problem-solving and critical thinking skills.
Preferred
- Associate or bachelor’s degree.
- Experience with Careviso, Glidian and Quadax systems
- Experience in molecular or genetic testing is preferred.
Working Conditions
Flexibility to work out of standard hours when necessary, including nights & weekends, holiday etc.
Physical Requirements
This job is primarily completing work from a desk.
#LI-Remote
Compensation
Hourly Rate: $21.68 - $23.99
Other compensation elements include:
- equity grant
- bonus eligible
ALERT: Malicious groups posing as Adaptive employees have recently used fraudulent email aliases to extend employment offers, provide fake documents, and request sensitive personal and financial information. Legitimate Adaptive employment opportunities are initiated through our careers page and extended after multiple interviews with verified employees. Adaptive does not ask new hires to purchase anything out-of-pocket, including home office supplies and equipment.
Interested in this position, but don’t meet all the requirements? Adaptive is committed to building diverse, equitable, and inclusive teams across our organization. Please consider applying even if your experience doesn’t match all the qualifications; you may be the exact candidate we’re searching for!
Adaptive is not currently sponsoring candidates requiring work authorization support for this position.
Adaptive’s posted compensation information includes a base salary (or hourly rate) range and summary of other available total compensation. The base salary range represents a minimum-to-maximum salary (or hourly rate) available to candidates upon extension of offer. Base salary is thoughtfully considered upon offer and is determined through multiple evaluation checks throughout the interview process, including: a candidate’s ability to meet minimum qualifications (skills/experience/education), a candidate’s ability to thoughtfully address preferred qualifications, current market conditions, and internal pay equity. Listed base salary is exclusive of bonus, commission, equity, differential pay, benefits, and other incentives.
Adaptive's benefits at-a-glance.
Adaptive Biotechnologies is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability. Please refer the “Know Your Rights: Workplace Discrimination is Illegal” Poster for more information. If you’d like to view a copy of the company’s affirmative action plan or policy statement, please email hr@adaptivebiotech.com.
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NOTE TO EMPLOYMENT AGENCIES: Adaptive Biotechnologies values our relationships with our Recruitment Partners and will only accept resumes from those partners who have active agreements with Adaptive. Adaptive Biotechnologies is not responsible for any fees related to resumes that are unsolicited or are received by any employee of Adaptive Biotechnologies who is not a member of the Human Resources team.