Prior Authorization Specialist

At Veracyte, we offer exciting career opportunities for those interested in joining a pioneering team that is committed to transforming cancer care for patients across the globe. Working at Veracyte – whether it be in one of our labs, corporate offices, the field – enables our employees to not only make a meaningful impact on the lives of patients, but to also learn and grow within a results-driven environment that values innovation, collaboration, and compassion.

The Position:

The successful candidate will be a rockstar in the health plan prior authorization management and processing. While working with our Reimbursement, Commercial, and Finance teams this role will provide on-going insight and analytics of the medical billing and reimbursement cycle. This position can be located in our South San Francisco or San Diego office (both hybrid) or can be remote.

*This is a full time, non-exempt role with a schedule of Monday through Friday, 8:30am-5pm PST.

Responsibilities:

• Processing of prior authorization cases via Glidian, EviCore and direct health plan portals
• Knowledge in insurance payor authorization guidelines, and follow-up of authorization status from health plan.
• Researching and responding to heavy authorization caseload in a timely manner.
• Reviewing and provide an analysis of prior authorization determination denials and approvals.
• Organize and maintain comprehensive files that include health plan prior authorization turnaround time, appeal guidelines and other pertinent information.
• Review medical records and respond to health plan clinical questions.
• Researching and monitoring of health plan issues, trends and potential risks and provide feedback to managers.
• Providing administrative support (when requested) including performing data entry, updating various record keeping systems, upholding company policies and Client requirements, and participating in projects, duties, and other administrative tasks.
• Knowledge, understanding, and compliance with all applicable Federal and Local laws and regulations relating to job duties.
• Knowledge, understanding, and compliance with Company policies and procedures.
• Other duties as assigned.

Who You Are

• 3-5 Years of direct appeals and billing experience
• Enthusiasm and an entrepreneurial spirit
• Familiarity with ICD and HCPC/CPT coding preferred
• Familiarity with CMS 1500 claim form preferred
• Familiarity with Claim Adjustment Reason Codes (NUCC) preferred
• Use of personal computer, computer applications, and general office equipment including scanners.
• Ability to create and maintain spreadsheets
• Ability to use analytical, interpersonal, communication, organizational, numerical, and time management skills.
• Experience handling and expediting escalated issues, with follow up to the customer.
• Ability to quickly assess a situation and take appropriate actions to address customer needs and requests in a timely and efficient manner. Self-starter with the ability to work independently and effectively in a team environment.
• Ability to organize and prioritize multiple projects/tasks and meet deadlines in a constantly evolving and fast-paced environment.
• Strong, consistent work ethic with a keen attention to details and ability to focus on the big picture.
• Excellent written and verbal communication skills.
• Must be able to communicate with confidence and tact across all levels within the company.

The final salary offered to a successful candidate will be dependent on several factors that may include but are not limited to the type and length of experience within the job, type and length of experience within the industry, education, etc. Base pay is one part of the Total Package that is provided to compensate and recognize employees for their work, and this role may be eligible for additional discretionary bonuses/incentives, and restricted stock units. Veracyte is a multi-state employer, and this salary range may not reflect positions that work in other states.

What We Can Offer You

Veracyte is a growing company that offers significant career opportunities if you are curious, driven, patient-oriented and aspire to help us build a great company. We offer competitive compensation and benefits, and are committed to fostering an inclusive workforce, where diverse backgrounds are represented, engaged, and empowered to drive innovative ideas and decisions. We are thrilled to be recognized as a 2024 Certified™ Great Place to Work® in both the US and Israel - a testament to our dynamic, inclusive, and inspiring workplace where passion meets purpose.

About Veracyte

Veracyte (Nasdaq: VCYT) is a global genomic diagnostics company that improves patient care by providing answers to clinical questions, informing diagnosis and treatment decisions throughout the patient journey in cancer and other diseases. The company’s growing menu of genomic tests leverage advances in genomic science and technology, enabling patients to avoid risky, costly diagnostic procedures and quicken time to appropriate treatment. The company’s tests in lung cancer, prostate cancer, breast cancer, thyroid cancer, bladder cancer and idiopathic pulmonary fibrosis are available to patients and its lymphoma subtyping and renal cancer tests are in development. With Veracyte’s exclusive global license to a best-in-class diagnostics instrument platform, the company is positioned to deliver its tests to patients worldwide. Veracyte is based in South San Francisco, California. For more information, please visit www.veracyte.com and follow the company on Veracyte">X (Formerly Twitter).

Veracyte, Inc. is an Equal Opportunity Employer and will consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disability status. Veracyte participates in E-Verify in the United States. View our CCPA Disclosure Notice.

If you receive any suspicious alerts or communications through LinkedIn or other online job sites for any position at Veracyte, please exercise caution and promptly report any concerns to Veracyte.com">[email protected]

Originally posted on Himalayas