Top 43 Prior authorization specialist Jobs in Somerset, Nj

Medical Authorization Specialist
CH Revenue Management Solutions (CHRMS) —Tinton Falls, NJ
- $23 - $27 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health savings account
- Disability insurance
Quick Apply
Prior Authorization Specialist
The Plastic Surgery Center —Red Bank, NJ
- $22 - $25 an hour
- Full-time
- Surgery
- HIPAA
- Mid-level
- Travel reimbursement
- Profit sharing
Quick Apply
Patient Responsibility, VOB & Authorization Specialist
CentralReach —Holmdel, NJ
- $45,000 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Communication skills
- Paid parental leave
- Health insurance
Quick Apply
1d
Prior Authorization Specialist
CentraState Healthcare System —Freehold, NJ
- $25 - $40 an hour
- Per diem
- Acute care
- Microsoft Excel
- Microsoft Outlook
- 403(b) matching
- AD&D insurance
Medical Insurance Eligibility Specialist
The Cardiovascular Care Group —Springfield, NJ
- $25 - $28 an hour
- Full-time
- Bilingual
- Customer service
- Medical office experience
- Paid jury duty
- Paid holidays
Quick Apply
HEALTHCARE AUTHORIZATION / PRE-CERTIFICATION SPECIALIST
Advanced Obstetrics & Gynecology —Flemington, NJ
- Full-time
- HIPAA
- Mid-level
- High school diploma or GED
Surgical Scheduling Specialist - PMPH
Penn Medicine —Plainsboro, NJ
- $18.11 - $28.86 an hour
- Mid-level
- High school diploma or GED
- Bachelor's degree
- Tuition reimbursement
Quick Apply
Pharmacy Specialist I
Horizon Blue Cross Blue Shield of New Jersey —Newark, NJ
- $44,600 - $59,745 a year
- Full-time
- High school diploma or GED
- Organizational skills
- Computer skills
- Health insurance
- Dental insurance
8d
Medical Office Associate I, Full Time - 9am-5pm, Women's Health, Martinsville
Atlantic Health System —Martinsville, NJ
- Full-time
- Administrative experience
- High school diploma or GED
- Communication skills
- 403(b) matching
- AD&D insurance
4d
Central Scheduling Specialist - Per Diem
Penn Medicine —Plainsboro, NJ
- $17.75 - $28.33 an hour
- Monday to Friday
- Medical office experience
- Mid-level
- High school diploma or GED
- Tuition reimbursement
Quick Apply
Administrative Specialist 1, Confidential
New Jersey Courts —Freehold, NJ
- $50,776.88 - $80,037.83 a year
- Full-time
- Hybrid work
- Background check
- Office
- Residential
- Paid holidays
- Health insurance
5d
Surgical Scheduler, Part Time - Days, Pediatric Surgery, Morristown
Atlantic Health System —Morristown, NJ
- Part-time
- Surgery
- Mid-level
- High school diploma or GED
- 403(b) matching
- AD&D insurance
10h
Patient Access Quality Specialist
Capital Health —Pennington, NJ
- $21.76 - $28.28 an hour
- Full-time
- Data analysis skills
- Mid-level
- 3 years
- AD&D insurance
- Disability insurance
Medical Office Associate I, Full Time - 8am-6pm, Family Medicine, Randolph
Atlantic Health System —Randolph, NJ
- Full-time
- Administrative experience
- High school diploma or GED
- Communication skills
- 403(b) matching
- AD&D insurance
13d
Release of Information Specialist - Mon–Fri 8:00 AM – 4:30 PM
Vital Holdings LLC —Orange, NJ
- $21 - $25 an hour
- Monday to Friday
- HIPAA
- Windows
- High school diploma or GED
Quick Apply
4d
Contact Center Representative
Affinity Federal Credit Union —Basking Ridge, NJ
- $48,000 - $50,000 a year
- Online Application
- Remote
- Spanish
- Mid-level
- US work authorization
- Profit sharing
- Health insurance
Quick Apply
Medical Billing and Insurance Specialist
Medical office management —Somerset, NJ
- $21 - $23 an hour
- Full-time
- Private practice
- Mid-level
- Clinic
- Health insurance
- Dental insurance
Quick Apply
Medical Receptionist - Central NJ Locations
Consensus Health LLC —Bridgewater, NJ
- $15.49 - $23.00 an hour
- Full-time
- Computer literacy
- Basic math
- Administrative experience
- Paid holidays
- Disability insurance
Quick Apply
Patient Scheduling Specialist
Rowe Plastic Surgery —Red Bank, NJ
- $22 - $24 an hour
- Weekends as needed
- Surgery
- HIPAA
- Mid-level
- Health insurance
Quick Apply
1d
Revenue Cycle Billing Specialist - FT - Day - Hospital Billing Lawrenceville NJ
Capital Health —Princeton, NJ
- $19.32 - $24.13 an hour
- 8 hour shift
- Microsoft Excel
- Medical office experience
- High school diploma or GED
- AD&D insurance
- Disability insurance

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Medical Authorization Specialist

CH Revenue Management Solutions (CHRMS)
Tinton Falls, NJ

Quick Apply

Job Details

Full-time
$23 - $27 an hour

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Health insurance authorizations
Microsoft Outlook
Health insurance information
High school diploma or GED
ICD-10
Attention to detail
Health insurance pre-authorization requirements
CPT coding
Organizational skills

Full Job Description

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:

Tinton Falls, NJ 07724 (Required)

Work Location: In person

Quick Apply

Refine Your Search

prior authorization specialist jobs in somerset, nj

Medical Authorization Specialist

Prior Authorization Specialist

Patient Responsibility, VOB & Authorization Specialist

Prior Authorization Specialist

Medical Insurance Eligibility Specialist

HEALTHCARE AUTHORIZATION / PRE-CERTIFICATION SPECIALIST

Surgical Scheduling Specialist - PMPH

Pharmacy Specialist I

Medical Office Associate I, Full Time - 9am-5pm, Women's Health, Martinsville

Central Scheduling Specialist - Per Diem

Administrative Specialist 1, Confidential

Surgical Scheduler, Part Time - Days, Pediatric Surgery, Morristown

Patient Access Quality Specialist

Medical Office Associate I, Full Time - 8am-6pm, Family Medicine, Randolph

Release of Information Specialist - Mon–Fri 8:00 AM – 4:30 PM

Contact Center Representative

Medical Billing and Insurance Specialist

Medical Receptionist - Central NJ Locations

Patient Scheduling Specialist

Revenue Cycle Billing Specialist - FT - Day - Hospital Billing Lawrenceville NJ

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