Prior Authorization Specialist

Adaptive Biotechnologies Corp.; United States; On-site; USD 29,000 - 33,000; Full time

Benefits offered by this job

Equity grant

Bonus eligible

Job summary

Adaptive Biotechnologies Corp. is seeking an experienced Prior Authorization Specialist to secure insurance approvals for the clonoSEQ MRD assay.

The role ensures timely, compliant processing and acts as a liaison between the lab, providers, and payers to minimize delays and optimize reimbursement. Requirements include a high school diploma (associate or bachelor’s preferred), 2+ years in prior authorization or medical billing, strong insurance knowledge, and proficiency in EMR systems and

Qualifications

• Minimum 2 years in prior authorization or medical billing.
• Strong understanding of insurance processes.
• Proficiency with EMR systems and Microsoft Office.
• Excellent communication and organizational skills.
• Ability to manage multiple priorities independently.
• Attention to detail and accuracy.

Responsibilities

• Submit and track prior authorization requests for clonoSEQ.
• Review clinical documentation for payer requirements.
• Communicate with insurers to resolve issues promptly.
• Maintain records in the RCM system per HIPAA.
• Identify trends in denials and escalate.
• Collaborate with billing and reimbursement teams.
• Develop best practices for workflows.
• All other duties as assigned.

Skills

Prior authorization

Medical billing

Insurance verification

Healthcare terminology

EMR systems

Microsoft Office

Attention to detail

Time management

Education

High school diploma

Associate degree preferred

Bachelor’s degree preferred

Tools

Careviso

Glidian

Quadax

Job description

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)

• 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.

Compensation

Hourly Rate: $21.68 - $23.99

Other Compensation Elements Include

• equity grant
• bonus eligible

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 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 [e-mail].

If you have a disability and you believe you need a reasonable accommodation to search for a job opening or to submit an online application, please e-mail [e-mail]. This email is created exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only messages left for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response.

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.