The Authorization Specialist is responsible for obtaining authorizations for surgical procedures, diagnostic testing, medications, DME, outgoing referrals, and other services as part of the Revenue Cycle Department.
This role supports patient care and reimbursement by ensuring that referrals and prior authorizations are completed accurately and on time, using a strong understanding of medical insurance, clinical policies, and health plan requirements.
Key responsibilities include:
- Identifying appointments and procedures that require authorization
- Determining referral and authorization requirements based on insurance plan guidelines
- Verifying insurance eligibility and benefits
- Completing referrals and prior authorizations according to workflow and deadlines
- Communicating with patients, physicians, office staff, supervisors, and payers to resolve issues
- Maintaining accurate patient account information
- Supporting denial prevention and reimbursement processes
- Handling work queues, reports, correspondence, and authorization-related system tasks
- Maintaining patient confidentiality
Requirements & Qualifications
Qualifications
- High school diploma or GED required
- Vocational or technical school diploma preferred
- 2-4 years of related experience preferred
- Experience with standard office equipment preferred
- Experience using Windows-based office technology and Microsoft Office Suite required
Skills and Knowledge
- Strong understanding of medical insurance and benefit terminology
- Knowledge of clinical policies, state guidelines, referrals, and prior authorization processes
- Ability to verify eligibility and benefits
- Experience preparing supporting documentation such as medical records, dictation, and orders
- Ability to investigate authorization denials and appeals
- Strong communication and organizational skills
- Familiarity with Epic and work queue/report processing is preferred
Benefits & Perks
Total rewards include access to a benefit platform with:
- Medical
- Dental
- Vision
- Life insurance
- Disability coverage
- FSA coverage
- 401(k) savings plan
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago