Top 6 prior authorization specialist Jobs in frederick md

Claims Specialist
GeneDx —Gaithersburg, MD
- $34 - $37 an hour
- Remote
- Mid-level
- Analysis skills
- Continuous improvement
- Paid parental leave
- Employee stock purchase plan
2d
Front Office Coordinator Float
Pivot Physical Therapy —Frederick, MD
- $15.00 - $23.50 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid parental leave
- Health savings account
Authorizations Specialist
SHERMAN KAHAN, M.D., P.A. —Frederick, MD
- $16 - $18 an hour
- Full-time
- HIPAA
- Research
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Billing and Insurance Authorization Specialist
Cumberland Valley Retina Consultants PC —Hagerstown, MD
- $19 - $23 an hour
- Full-time
- Medical office experience
- Mid-level
- Organizational skills
- Health insurance
- Dental insurance
Quick Apply
5d
Front Office Coordinator
Pivot Physical Therapy —Eldersburg, MD
- $15.00 - $23.50 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid parental leave
- Health savings account

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Prior Authorization Specialist
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Must have prior experience with insurances and prior authorizations. Collaborate with clinical staff to ensure timely approvals for patient treatments.
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Claims Specialist

GeneDx -
Gaithersburg, MD

Apply Now

Job Details

$34 - $37 an hour
2 days ago

Benefits

Paid parental leave
Employee stock purchase plan
Health insurance
Dental insurance
401(k)
Paid time off
Adoption assistance
Parental leave
Vision insurance
Employee discount
Life insurance

Qualifications

Video conferences (communication methods)

Full Job Description

Summary

The Claims Specialist is responsible for managing the end-to-end claims process for diagnostic laboratory services, ensuring timely and accurate submission, follow-up, and resolution of insurance claims. This role is critical to maximizing reimbursement, reducing denials, and supporting the financial health of the laboratory.

Job Responsibilities

Claims Submission:
Prepare, review, and submit claims for diagnostic lab services to commercial and government payers, ensuring compliance with payer guidelines and laboratory policies.

Denial Management:
Analyze denied claims, identify root causes, and initiate corrective actions including appeals and resubmissions.

Follow-Up:
Proactively follow up on outstanding claims, monitor aging reports, and communicate with payers to resolve issues and expedite payment.

Documentation:
Maintain accurate records of claim status, correspondence, and payer responses in the billing system.

Collaboration:
Work closely with prior authorization, billing, and reimbursement teams to resolve complex claims and support cross-functional RCM initiatives.

Compliance:
Stay current with payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting laboratory claims.

Reporting:
Generate and analyze claims performance reports to identify trends, opportunities for process improvement, and support management decision-making.

Education, Experience, and Skills

Associate's or Bachelor's degree in healthcare administration, business, or related field (preferred).

2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting.

Strong knowledge of insurance billing, payer requirements, and denial management.

Familiarity with laboratory coding (CPT, ICD-10), EOBs, and remittance advice.

Proficiency with billing software and Microsoft Office Suite.

Excellent attention to detail, organizational, and communication skills.

Ability to work independently and collaboratively in a fast-paced environment.

Work Environment

This is a fully remote position. The employee will work from a home office or other suitable remote location with reliable high-speed internet access. Work is performed in a climate-controlled environment using standard office equipment including computer, phone, and video conferencing tools. Your standard work schedule and hours will be established in collaboration with your leader and may be adjusted to align with evolving business needs.

Physical Demands

This is a sedentary role requiring prolonged periods of sitting while working at a computer. Physical demands include:

Sitting for extended periods (up to 8 hours per day)

Repetitive use of hands and fingers for typing and mouse operation

Visual acuity for reading computer screens and documents

Ability to communicate effectively via phone and video calls

Occasional lifting of up to 10 pounds (office supplies, equipment)

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Acknowledgements

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

#LI-REMOTE

Science - Minded, Patient - Focused.

At GeneDx, we create, follow, and are informed by cutting-edge science. With over 20 years of expertise in diagnosing rare disorders and diseases, and pioneering work in the identification of new disease-causing genes, our commitment to genetic disease detection, discovery, and diagnosis is based on sound science and is focused on enhancing patient care.

Experts in what matters most.

With hundreds of genetic counselors, MD/PhD scientists, and clinical and molecular genomics specialists on staff, we are the industry's genetic testing experts and proud of it. We share the same goal as healthcare providers, patients, and families: to provide clear, accurate, and meaningful answers we all can trust.

SEQUENCING HAS THE POWER TO SOLVE DIAGNOSTIC CHALLENGES.

From sequencing to reporting and beyond, our technical and clinical experts are providing guidance every step of the way:

TECHNICAL EXPERTISE

High-quality testing: Our laboratory is CLIA certified and CAP accredited and most of our tests are also New York State approved.
Advanced detection: By interrogating genes for complex variants, we can identify the underlying causes of conditions that may otherwise be missed.

CLINICAL EXPERTISE

Thorough analysis: We classify variants according to our custom adaptation of the most recent guidelines. We then leverage our rich internal database for additional interpretation evidence.
Customized care: Our experts review all test results and write reports in a clear, concise, and personalized way. We also include information for research studies in specific clinical situations.
Impactful discovery: Our researchers continue working to find answers even after testing is complete. Through both internal research efforts and global collaborations, we have identified and published hundreds of new disease-gene relationships and developed novel tools for genomic data analysis. These efforts ultimately deliver more diagnostic findings to individuals.

Learn more About Us here.

A culture that plays to win, because patients are counting on us

At GeneDx, we're driven by urgency and purpose: helping patients get diagnosed earlier. Our mission, to empower everyone to live their healthiest life through genomics, drives our team to make a tangible impact each day – and shapes our culture where high standards, strong teamwork, and meaningful ownership are the norm. We act with intention, support one another, and deliver work we're proud to put our names on.

Here's what you can expect day to day:

1. Play like a champion (step up, redefine what's possible, own it)

We bring energy, focus, and a bias for action. We step up, take initiative, and deliver on our commitments – with quality, speed, and care.

2. Think bigger (stretch beyond, courage not consensus)

We push past the obvious. We challenge assumptions, raise the bar, and make thoughtful, decisive calls — choosing progress over perfection.

3. Grow fast (be curious, speak up, be agile)

We stay curious, ask questions, and share direct feedback with respect. We adapt quickly and keep learning through collaboration and continuous improvement.

If you're motivated by meaningful work, a fast-moving environment, and teammates who care deeply about outcomes, you'll thrive at GeneDx.

Benefits include:

Paid Time Off (PTO)
Health, Dental, Vision and Life insurance
401k Retirement Savings Plan
Employee Stock Purchase Plan
Employee Discounts
Voluntary benefits
Programs for parents and parents-to-be
- We provide expert support for family planning, pregnancy, and postpartum care, including up to 22 weeks of fully paid parental leave (U.S.) and up to $25K annually for fertility, adoption, or surrogacy.

GeneDx is an Equal Opportunity Employer.

All privacy policy information can be found here.

Apply Now

Refine Your Search

prior authorization specialist jobs in frederick md

Claims Specialist

Front Office Coordinator Float

Authorizations Specialist

Billing and Insurance Authorization Specialist

Front Office Coordinator

Discover related jobs

Explore jobs in cities nearby

I want to receive the latest job alert for prior authorization specialist in frederick md

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A culture that plays to win, because patients are counting on us

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