Prior Authorization Specialist

Job Title: Prior Authorization Specialist Department: Revenue Cycle / Billing Reports To: Sr. Director of Billing and Reimbursement Location: Onsite Preferred – Work From Home Position Summary The Prior Authorization Specialist is responsible for the timely and accurate submission of prior authorizations for Category I molecular pathology testing. The role requires reviewing clinical documentation, applying payer-specific medical necessity criteria, and ensuring alignment between CPT and ICD-10 coding. This position supports revenue cycle performance by minimizing authorization-related denials and delays. Core Responsibilities Submit and manage high-volume prior authorizations ( ~75-100 per day ) Review and interpret medical records, clinical documentation, and lab requisitions Responsible for reviewing and submitting authorization level appeals Data entry, correct insurance assignment to patient accounts, insurance eligibility verification Review/update demographics and patient information for accuracy Ensure appropriate linkage between CPT codes and ICD-10 diagnoses Apply payer policies across Commercial, Medicare Advantage, and Medicaid payers Utilize payer portals, automated tools, and internal systems to process authorizations Monitor and track authorization statuses and complete required follow-up actions Collaborate with internal billing teams to resolve authorization discrepancies Maintain full compliance with HIPAA regulations and payer guidelines Minimum Qualifications 2–4 years of relevant experience in: Prior authorization processing Laboratory billing Healthcare revenue cycle High school diploma required; some college preferred Working knowledge of: CPT coding (molecular preferred) ICD-10 coding and medical necessity guidelines Ability to interpret clinical documentation and testing requests Strong knowledge and experience with Microsoft Excel as well as Word and Outlook, general office equipment, and ten-key by touch Ability to easily adapt to increased business demands Skills & Competencies Strong analytical and critical thinking skills High level of attention to detail and accuracy Ability to interpret and apply payer policies Effective internal communication skills Ability to work in a high-volume, production-driven environment Strong organizational and multi-tasking capabilitiesSelf-starter, ability to work independently. Excellent communication and customer service skills; cooperative, work collaboratively and treat others in respectful, professional and supportive manner. Desire to learn and apply learned concepts to various situations. Tools & Systems Salesforce Glidian XIFIN Payer portals and automated authorization platforms Microsoft Excel Performance Expectations Meet or exceed daily productivity targets (authorization volume) Maintain high accuracy and data integrity Ensure timely submission and follow-up Adhere to payer requirements and compliance standards The annualized base salary range for this role is $48,800 to $73,300 and is bonus eligible. Final compensation packages will ultimately depend on factors including relevant experience, skillset, knowledge, geography, education, business needs and market demand. Hologic, Inc. is proud to be an Equal Opportunity Employer inclusive of disability and veterans. #J-18808-Ljbffr