Insurance Verification & Prior Authorization Specialist

Job Summary:

A well-established group medical practice in Passaic County, NJ, is seeking a Pre-Authorization Specialist to join our team. This role is responsible for obtaining prior authorizations for medical procedures, verifying insurance benefits, and ensuring compliance with payer guidelines. The ideal candidate is detail-oriented, highly organized, and experienced in navigating insurance requirements in a fast-paced healthcare setting.

Key Responsibilities:

• Obtain prior authorizations for diagnostic tests, imaging, procedures, and medications by submitting requests to insurance carriers.
• Review and interpret CPT, ICD-10, and HCPCS codes to ensure accurate authorization submissions.
• Verify patient eligibility, benefits, and coverage details using insurance portals such as Navinet, Availity, and payer websites.
• Communicate with insurance companies to resolve authorization delays, denials, and discrepancies.
• Collaborate with physicians, medical staff, and billing teams to ensure timely approvals and compliance with insurance policies.
• Inform patients of authorization status, out-of-pocket costs, and financial responsibilities before procedures.
• Document authorization approvals, denials, and appeals in the electronic medical record (EMR) system.
• Maintain knowledge of insurance carrier policies, prior authorization guidelines, and regulatory changes.

Qualifications & Skills:

• Experience: Minimum of 2 years in a pre-authorization, prior authorization, or medical billing role within a healthcare setting.
• Knowledge: Strong understanding of insurance policies, authorization processes, and medical terminology.
• Technical Skills: Proficiency in electronic medical records (EMR) systems and insurance verification portals.
• Communication: Excellent verbal and written communication skills to interact with patients, providers, and insurers.
• Detail-Oriented: Ability to handle multiple authorization requests while maintaining accuracy and efficiency.
• Problem-Solving: Capable of identifying and resolving insurance authorization issues proactively.

Preferred Qualifications:

• Prior experience working in a multi-specialty or gastroenterology, cardiology, or orthopedic practice.
• Familiarity with EHR systems such as ECW (eClinicalWorks) or Epic.
• Bilingual in Spanish and English is a plus.