Prior Authorization Specialist - Epic Claims & Reimbursement

Abbott Laboratories; Madison (WI); On-site; USD 20,000 - 41,000; Full time

Job summary

Exact Sciences seeks a Prior Authorization Associate Level I to manage patient insurance eligibility, connect with payors, and ensure timely authorization for claims. The role involves cross-functional collaboration across sales, operations, billing, and lab teams within a HIPAA-compliant environment.

Responsibilities include handling high volumes of prior authorization requests, navigating Epic workflows, and ensuring accurate documentation to support reimbursements.

Qualifications

• High School Diploma or GED required.
• 3 years experience in medical billing, claims, and/or insurance processing.
• 2+ years in submission and follow up of Prior Authorization workflows.
• Familiarity with Epic or other EHR systems is preferred.

Responsibilities

• Verify initial/ongoing patient insurance eligibility and update demographic/financial info.
• Interact with insurances to obtain authorizations per policies.
• Review and edit claims and appeals before submission to clearinghouse.
• Analyze denial reasons and resolve issues with payors.

Skills

Problem solving

Organizational skills

Communication

Team player

Self-motivated

Attention to detail

Time management

HIPAA compliance

Education

High School Diploma or GED

Associate degree

Medical billing certification

Tools

Epic

Other EHR applications

Job description

Exact Sciences seeks a Prior Authorization Associate Level I to manage patient insurance eligibility, connect with payors, and ensure timely authorization for claims. The role involves cross-functional collaboration across sales, operations, billing, and lab teams within a HIPAA-compliant environment.

Responsibilities include handling high volumes of prior authorization requests, navigating Epic workflows, and ensuring accurate documentation to support reimbursements.