Prior Authorization Expert

Agendia; Irvine (CA); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player in precision oncology is seeking a dedicated Prior Authorization Expert to join their team in Irvine. This full-time, on-site role involves managing authorization processes to ensure timely approvals for genomic testing. The ideal candidate will have a strong understanding of medical billing, CPT, and ICD-10 codes, and will work closely with healthcare providers and insurance companies. This is an excellent opportunity to contribute to improving patient outcomes in the field of breast cancer treatment while collaborating with innovative teams. If you're passionate about healthcare and have the skills to streamline authorization procedures, this role is perfect for you.

Qualifications

• 1+ years experience in medical billing or prior authorization preferred.
• Strong knowledge of CPT and ICD-10 codes required.

Responsibilities

• Manage prior authorization processes for genomic testing.
• Verify diagnosis codes and submit authorization forms to payors.

Skills

Medical Billing Knowledge

Authorization Processes

ICD-10 Code Knowledge

CPT Code Knowledge

Communication Skills

Education

High School Diploma

Tools

Electronic Authorization Platforms

Fax Machines

Job description

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Company Description

Agendia is a precision oncology company based in Irvine, California, dedicated to providing patients with early stage breast cancer and their physicians the necessary information for optimal treatment decisions. The company offers two genomic profiling tests, MammaPrint and BluePrint, which deliver comprehensive genomic information to personalize breast cancer treatment. Agendia collaborates with leading companies to develop innovative digital tools and conducts ongoing research to enhance patient outcomes and clinical support.

Role Description

This is a full-time on-site role for a Prior Authorization Expert at Agendia in Irvine, CA. The Prior Authorization Expert will be responsible for managing prior authorization processes, ensuring timely approval of prior authorizations, and liaising with healthcare providers and insurance companies to obtain necessary authorizations for genomic testing. They will also collaborate with internal teams to streamline authorization procedures and maintain accurate documentation.

Main Responsibilities:

1. Verify diagnosis codes against current ICD-10 requirements
2. Complete authorization forms via paper or online platforms
3. Submit authorizations to payors via fax, electronic portals, or third-party vendors
4. Follow up on open authorization submissions and notify billing staff of determination receipt

Requirements:

1. High school diploma or equivalent education
2. At least 1 year of related experience, preferably in medical billing or authorization
3. Knowledge of CPT and ICD-10 codes
4. Ability to read and understand medical payer policies and pathology reports

Apply online at www.agendia.com

Seniority level

Entry level

Employment type

Full-time

Industries

Biotechnology