Top 35 Prior authorization specialist Jobs in Eatontown Nj

Authorization Specialist
KabaFusion —Edison, NJ
- $28 - $32 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Paid holidays
- Disability insurance
Quick Apply
2d
Patient Access Specialist - Per Diem - Day
Hackensack Meridian Health —Red Bank, NJ
- From $25.77 an hour
- Rotating weekends
- Spanish
- Hospital
- Computer literacy
- Health insurance
- Dental insurance
Patient Access Specialist - Part Time - Night
Hackensack Meridian Health —Neptune City, NJ
- From $25.77 an hour
- Part-time
- Spanish
- Hospital
- Computer literacy
- Health insurance
- Dental insurance
Medicaid Authorization & Documentation Specialist
Volunteers of America - Greater New York, Inc. —Rahway, NJ
- $60,000 a year
- Full-time
- Mid-level
- Driver's License
- Bachelor's degree
- Paid holidays
- Health insurance
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Accounts Receivable Insurance Authorization Specialist
Swan Hospice —Lakewood, NJ
- Full-time
- Mid-level
- Hospice & Palliative Medicine
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4d
Care Coordination Specialist
Hackensack Meridian Health —Neptune City, NJ
- From $23.13 an hour
- Full-time
- Word processing
- Mid-level
- 3 years
- Health insurance
- Dental insurance
10d
Billing and Collections Representative
Always Home Care —Brooklyn, NY
- $50,000 - $80,000 a year
- Full-time
- Management
- Research
- Mid-level
- Health insurance
- Dental insurance
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Medical Receptionist- Part Time
Consensus Health LLC —Freehold, NJ
- $16 - $23 an hour
- Part-time
- Computer literacy
- Basic math
- Administrative experience
- Paid holidays
- Disability insurance
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12d
Medical Receptionist - Central NJ Locations
Consensus Health LLC —Marlboro, NJ
- $15.49 - $23.00 an hour
- Full-time
- Computer literacy
- Basic math
- Administrative experience
- Paid holidays
- Disability insurance
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Medical Receptionist- Southern NJ
Consensus Health LLC —Freehold, NJ
- $15.49 - $23.00 an hour
- Full-time
- Computer literacy
- Basic math
- Administrative experience
- Paid holidays
- Disability insurance
Quick Apply
Front Desk Receptionist
US Foot & Ankle Specialists —Toms River, NJ
- $20 - $22 an hour
- Microsoft Excel
- Microsoft Outlook
- Sales
- Paid holidays
- Disability insurance
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Surgery Center Coordinator
Chord Specialty Dental Partners —Township of Jackson, NJ
- $18 - $20 an hour
- Full-time
- Spanish
- Surgery
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
Medical Accounts Receivable Specialist
OIBortho —Toms River, NJ
- $19 - $23 an hour
- Full-time
- Mid-level
- In-person
- Medical terminology
- Health insurance
- Dental insurance
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4d
Senior Medical Secretary (FGP) - Brooklyn, Ft. Hamilton
NYU Langone Health —Brooklyn, NY
- $79,093.35 a year
- Online Application
- Surgery
- Computer literacy
- Writing skills
- Wellness program
12d
Secretary I-Intake/Scheduler (FGP) Clinton Hill (Brooklyn), Multispeciality
NYU Langone Health —Brooklyn, NY
- $56,873.24 - $56,873.25 a year
- Online Application
- Word processing
- Computer literacy
- Writing skills
- Wellness program
Sec II-Intake/Sched (FGP), Brooklyn NY 11229, Multispeciality
NYU Langone Health —Brooklyn, NY
- $61,692.75 a year
- Online Application
- HIPAA
- Mid-level
- 3 years
- Wellness program
Billing Specialist - Brooklyn, NY
OOS Management Corp. —Brooklyn, NY
- $20 - $27 an hour
- Full-time
- Mid-level
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Adult Medicine Patient Services Associate - Brooklyn
NYU Langone Health —Brooklyn, NY
- $50,936.42 a year
- Online Application
- Microsoft Outlook
- HIPAA
- Administrative experience
- Wellness program
12d
Medical Receptionist
Consensus Health LLC —Manasquan, NJ
- $16 - $23 an hour
- Part-time
- Computer literacy
- Basic math
- Administrative experience
- Paid holidays
Quick Apply

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Authorization Specialist

KabaFusion -
Edison, NJ

Quick Apply

Job Details

Full-time
$28 - $32 an hour
2 days ago

Benefits

Paid holidays
Disability insurance
Paid time off
401(k) 4% Match
Employee assistance program
401(k) matching
Life insurance
Referral program

Qualifications

Appeals
Overseeing health insurance pre-certification
Medicare
Overseeing healthcare denial management
Caseload management
Writing skills
Patient financial aid assistance
High school diploma or GED
Medicaid health insurance
HCPCS
Case appeal in utilization management
Medicare regulations
Medicaid
Healthcare reimbursement methods
Insurance claims appeal handling

Full Job Description

Come join an exciting and innovative company that puts the “care” back in healthcare!

At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work.

About Us:

What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion.

JOB SUMMARY:

This position is responsible for managing complex and high-risk eligibility, authorization, and financial assistance cases within home infusion services. This role specializes in escalations, second-level appeals, complex reimbursement issues, and challenging copayment assistance scenarios. In addition, this position plays a key role in removing payer and financial barriers to care, ensuring timely patient access to therapy while maintaining compliance with payer requirements and organizational standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Manage escalated authorization cases involving complex payer requirements and non-standard scenarios.

2. Lead second-level appeals, including preparing detailed documentation, clinical justification, and payer communication.

3. Troubleshoot and resolve complex Revenue Cycle Management related issues tied to authorization, denials, and reimbursement barriers.

4. Manage challenging copayment assistance cases, including coordination with foundations, manufacturers, and internal teams.

5. Identify potential areas for retraining and support management and intake training team to implement a training plan.

6. Assist with covering intake, eligibility, and authorization workflows as needed.

7. Serve as the subject matter expert on authorization workflows, payer policies, and escalation pathways.

8. Work closely with intake, clinical, pharmacy, and billing teams to ensure seamless patient onboarding and continuity of care.

9. Proactively identify risks to authorization approval or reimbursement and implement mitigation strategies.

10. Assist with writing standard operating procedures, policies, information tools, and training tools.

11. Maintain accurate, thorough documentation in all systems to ensure compliance and audit readiness.

12. Identify trends in denials or escalation cases and recommend process improvements.

13. Assist with any projects that require authorization, copay assistance, demographic entry, or eligibility expertise.

14. Other related duties as assigned by manager or designee.

JOB REQUIREMENTS AND QUALIFICATIONS

Education:

High school diploma or equivalent required.
Associate or bachelor’s degree in health care of related field preferred.

Experience

Minimum three (3) years of experience in healthcare authorizations, insurance verification, reimbursement, or revenue cycle operations, preferably in home infusion, specialty pharmacy, or a related healthcare setting.
Experience managing prior authorizations, second-level appeals, and payer requirements for specialty therapies, infusion services, and high-cost medications.
Knowledge of commercial, Medicare, and Medicaid payer guidelines, authorization processes, and reimbursement requirements.
Working knowledge of HCPCS, CPT, and other applicable coding systems related to infusion and specialty pharmacy services.
Experience obtaining authorizations and reimbursement for specialty, biologic, and high-cost medications.
Understanding of revenue cycle management (RCM) processes and the impact of authorizations on reimbursement and claims outcomes.
Experience navigating copay assistance, patient assistance, and other financial support programs for specialty therapy patients.
Proficient experience with Microsoft Office including Word, Excel, PowerPoint, Outlook, Teams, and CPR+ software system or similar system preferred.

Skills and Competencies:

Strong knowledge of prior authorization processes, payer guidelines, and coverage requirements across commercial, Medicare, and Medicaid plans.
Ability to interpret insurance benefits, medical necessity criteria, coverage determinations, and complex payer policies to support successful authorization and appeal outcomes.
Proven ability to manage complex or escalated authorization cases, including denials, appeals, and difficult approvals.
Understanding of revenue cycle management (RCM) processes and the impact of authorizations on reimbursement and financial outcomes.
Strong critical thinking, analytical, and problem-solving skills with the ability to identify barriers and develop effective solutions.
Excellent verbal and written communication skills, including the ability to communicate effectively in highpressure or sensitive situations.
Demonstrated ability to work independently, prioritize competing demands, and manage multiple cases simultaneously while maintaining accuracy and timeliness.
Strong attention to detail and commitment to quality, compliance, and patient-centered service.

What we offer:

Competitive compensation

Benefits start on your 1st day of employment

401k w 4% match – no waiting or vesting period

PTO / Floating Holidays / Paid Holidays

Company paid life insurance, short term disability

Employee Assistance programs to help with mental health / wellness

Learning & Development Programs

Perks… includes discounts on travel, cell phone, clothing and more…

Generous employee referral program

To learn more about KabaFusion, please visit our careers page: https://www.kabafusion.com/careers/

Join us and find out why this is the place to excel and do your best work.

Quick Apply

Refine Your Search

prior authorization specialist jobs in eatontown nj

Authorization Specialist

Patient Access Specialist - Per Diem - Day

Patient Access Specialist - Part Time - Night

Medicaid Authorization & Documentation Specialist

Accounts Receivable Insurance Authorization Specialist

Care Coordination Specialist

Billing and Collections Representative

Medical Receptionist- Part Time

Medical Receptionist - Central NJ Locations

Medical Receptionist- Southern NJ

Front Desk Receptionist

Surgery Center Coordinator

Medical Accounts Receivable Specialist

Senior Medical Secretary (FGP) - Brooklyn, Ft. Hamilton

Secretary I-Intake/Scheduler (FGP) Clinton Hill (Brooklyn), Multispeciality

Sec II-Intake/Sched (FGP), Brooklyn NY 11229, Multispeciality

Billing Specialist - Brooklyn, NY

Adult Medicine Patient Services Associate - Brooklyn

Medical Receptionist

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