Molecular and Genetic Laboratory billing and authorization specialist
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Clin Path-Molecular
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State of New York
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TH Staff Assistant 2, NSSL1
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90564
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UUP (State University Professional Services Unit)
Job Summary:
The Molecular & Genetic Prior Authorization & Billing Specialist plays a critical role in ensuring patients receive timely access to laboratory testing by securing insurance authorizations and supporting accurate reimbursement for molecular, genetic, and other specialized laboratory tests.
Key responsibilities include:
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Managing Prior Authorizations: Obtain insurance authorizations for molecular, genetic, and other laboratory testing by coordinating with insurance carriers, providers, and patients.
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Verifying Documentation & Medical Necessity: Review medical records, obtain diagnosis codes and clinical documentation, and ensure all payer requirements are met prior to testing.
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Supporting Billing & Reimbursement: Help prevent claim denials by verifying insurance eligibility, monitoring authorization status, and resolving authorization and reimbursement issues.
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Maintaining Compliance & Collaboration: Document authorization activities accurately and partner with laboratory staff, providers, billing teams, and insurance representatives while staying current on payer policies and regulatory requirements
Minimum Qualifications:
Associates degree in Healthcare Administration, Nursing, Laboratory, Billing or related field. At least 2 years of experience in prior authorization, medical billing, or revenue cycle operations.
Preferred Qualifications:
Certified Prior Authorization Specialist (PACS). Proficient with EHR/EPIC, LIS/Beaker systems and insurance portals. Strong verbal and written skills for interacting with providers, payers, and patients. Knowledge of ICD-10, CPT coding, and payer authorization requirements. Experience navigating commercial and government payer portals. Strong analytical and problem-solving skills with the ability to resolve authorization and denial issues effectively. Excellent attention to detail and accuracy in completing authorization forms, documentation, and follow-up activities. Organizational, communication, and time-management skills.
Work Days:
M-F 8:30-5:00
Message to Applicants:
Recruitment Office: Human Resources