CH Revenue Management Solutions (CHRMS) is seeking a Medical Authorization Specialist to join its growing team. CHRMS represents out-of-network surgeons throughout the United States in the medical claim reimbursement cycle, from medical billing through appeals, including claims through the arbitration process under Federal and State laws. Our team is comprised of more than 60 professional medical billers, coders, insurance professionals, and industry experts. This opportunity is for the right individual to be part of an entrepreneurial work environment with a good work/life balance.
The Medical Authorization Specialist is responsible for obtaining and managing insurance authorizations and pre-certifications for out-of-network medical services to ensure timely reimbursement and compliance with payer requirements. This role serves as a key liaison between providers, patients, and insurance companies, helping to minimize denials and delays in care.
THIS IS A FULL-TIME IN OFFICE POSITION.
Key Responsibilities:
- Obtain prior authorizations and pre-certifications for scheduled and urgent medical services by out-of-network providers.
- Seek GAP authorizations when required.
- Verify insurance benefits, coverage limitations, and authorization requirements.
- Submit complete and accurate authorization requests through payer portals, phone, or fax.
- Track authorization status and follow up with payers to ensure timely approvals.
- Request, negotiate and complete single case agreements and letter agreements.
- Communicate authorization determinations, requirements, and delays to providers, scheduling teams, and patients.
- Review clinical documentation to ensure it meets payer medical necessity criteria.
- Identify and escalate authorization denials or delays for appeal or peer-to-peer review.
- Maintain accurate records of authorization activity in company IT systems.
- Track authorization-related denial trends and escalate recurring payer issues.
- Stay current on payer policies, authorization rules, state and federal regulations, and out-of-network reimbursement rules.
- Support denial prevention initiatives and revenue cycle performance improvement efforts.
- Work with billing and appeals teams to support denial prevention and appeal strategies.
Skills & Competencies:
- Proficiency in Microsoft Office programs, especially Outlook, Word, and Excel.
- Strong knowledge of insurance plans (commercial, Medicare, Medicaid) and authorization processes.
- Familiarity with CPT, ICD-10, and medical terminology.
- Experience working with payer portal systems.
- Strong attention to detail and organizational skills.
- Excellent verbal and written communication skills.
- Ability to manage high volumes and meet time-sensitive deadlines.
- Ability to work in a fast-paced healthcare environment with frequent client, payer and patient interaction.
Education & Experience:
- High school diploma or equivalent required; associate or bachelor’s degree preferred
- 2+ years of experience in medical authorizations, patient access, or revenue cycle operations, with experience in out-of-network authorization
- Experience with surgical procedures
- Experience with specialty services (e.g., plastic, orthopedic, etc.)
- Prior experience with appeals and peer-to-peer coordination
- Knowledge of out-of-network authorization processes and medical necessity requirements
- Knowledge of state-specific surprise billing and balance billing regulations, A PLUS
Salary & Benefits:
- Salary range-$23.00-$27.00 based upon experience.
EOE/DFWP
Job Type: Full-time
Pay: $23.00 - $27.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- Do you have any experience with state specific surprise billing and balance billing regulations?
Experience:
- medical authorizations: 2 years (Required)
- out-of-network authorization: 2 years (Required)
Ability to Commute:
- Red Bank, NJ 07701 (Required)
Work Location: In person
