Prior Authorization Specialist

Adaptive Biotechnologies; United States; Hybrid; USD 29,866 - 33,048; Full time

Benefits offered by this job

Equity grant

Bonus eligible

Job summary

Adaptive Biotechnologies is seeking a Prior Authorization Specialist responsible for obtaining insurance approvals for clonoSEQ MRD Assays. This role involves managing prior authorizations to ensure patient access to laboratory services, acting as a liaison with healthcare providers and insurance companies.

The ideal candidate will have at least 2 years of experience in prior authorization or medical billing and must exhibit exceptional communication skills, attention to detail, and proficiency in EMR systems. A flexible working arrangement may be required.

Qualifications

• Minimum 2 years in prior authorization or medical billing.
• Strong understanding of insurance processes.
• Ability to work independently and manage multiple priorities.

Responsibilities

• Submit and track prior authorization requests.
• Maintain records of all authorization activities.
• Communicate with insurance companies to resolve issues.

Skills

Prior authorization management

Medical billing

Insurance verification

Excellent communication skills

Proficiency in EMR systems

Attention to detail

Education

High school diploma or equivalent

Associate or bachelor's degree (preferred)

Tools

Microsoft Office Suite

Careviso

Glidian

Quadax

Job description

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 report 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.

Working Conditions

Flexibility to work out of standard hours when necessary, including nights, weekends, holidays, etc.

Physical Requirements

This job is primarily completing work from a desk.

Compensation

Hourly Rate: $21.68 - $23.99

• Equity grant
• Bonus eligible

Equal Employment Opportunity Statement

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 to 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].

Accommodation Statement

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.

Recruitment Agency Statement

Note to employment agencies: Adaptive Biotechnologies values its relationships with 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.