Prior Authorization Specialist

San Diego, CA, United States

**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 submitti...