Top 47 Prior authorization specialist Jobs in Somerville, Nj

PAHub & Prior Authorization Specialist
Agadia Systems Inc —Parsippany-Troy Hills, NJ
- $90,000 - $120,000 a year
- Full-time
- Remote
- 5 years
- HIPAA
- Analysis skills
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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
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2d
HEALTHCARE AUTHORIZATION / PRE-CERTIFICATION SPECIALIST
Advanced Obstetrics & Gynecology —Flemington, NJ
- Full-time
- HIPAA
- Mid-level
- High school diploma or GED
Medical Office Associate I, Full Time - 8am-4pm, Gastroenterology, Bridgewater
Atlantic Health System —Bridgewater, NJ
- Full-time
- Administrative experience
- High school diploma or GED
- Communication skills
- 403(b) matching
- AD&D insurance
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
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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
2d
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
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Medical Billing Specialist ( on-site)
Asembia LLC —Livingston, NJ
- $18 - $23 an hour
- 8 hour shift
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
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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
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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
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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
Prior Authorization Specialist
Polaris Pharmacy Services —Rockaway, NJ
- $23 - $25 an hour
- Extended hours
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Paid holidays
- Disability insurance
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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 - Days, Internal Medicine, Summit
Atlantic Health System —Summit, NJ
- Full-time
- Internal Medicine
- Administrative experience
- High school diploma or GED
- 403(b) matching
- AD&D insurance
2d
Senior Revenue Cycle Billing Specialist - FT - Day - MSO/Centralized Billing Lawrenceville NJ
Capital Health —Princeton, NJ
- $20.10 - $26.13 an hour
- 8 hour shift
- Microsoft Excel
- Medical office experience
- Mid-level
- AD&D insurance
- Disability insurance
Front Office Specialist - Medication Management - Millburn, NJ
OASIS MENTAL HEALTH CENTERS MEDICAL LLC —Millburn, NJ
- $22 - $24 an hour
- 8 hour shift
- Ability to sit for extended periods
- Organizational skills
- 1 year
- 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
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
Pharmacy Technician FrameworkLTC Data Entry & Billing Specialist
LTC Scripts Inc —Long Valley, NJ
- $40,000 - $55,000 a year
- Full-time
- Customer service
- HIPAA
- Mid-level
- Paid training
- Health insurance
Quick Apply
Sr. Billing Specialist
Heart to Heart Health Care Services LLC —East Orange, NJ
- $25 - $32 an hour
- Full-time
- HIPAA
- Mid-level
- Residential

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PAHub & Prior Authorization Specialist

Agadia Systems Inc -
Parsippany-Troy Hills, NJ

Quick Apply

Job Details

Full-time
$90,000 - $120,000 a year

Qualifications

Customer communication
HIPAA compliance
HIPAA
Managing clients in a customer support role
IT experience within healthcare
Clinical confidentiality policies
Healthcare software applications

Full Job Description

Reports To: Vice President, Customer Experience

Location: Remote/Hybrid with 10% travel nationwide

Position Summary

The PAHub & Prior Authorization Specialist serves as a trusted consultant to customers and internal teams, helping maximize the value, effectiveness, and adoption of PAHub. This role bridges the gap between product functionality, customer operations, implementation, account management, training, and support.

The ideal candidate possesses deep knowledge of prior authorization workflows and PAHub capabilities and can effectively communicate with both operational users and executive stakeholders. The Specialist will participate in customer meetings, support internal teams, provide product demonstrations, identify optimization opportunities, and assist in the development of customer-facing documentation and training materials.

This role plays a critical part in ensuring customers achieve their desired business outcomes while helping internal teams deliver consistent, high-quality customer experience.

Key Responsibilities

Customer Engagement & Advisory

Serve as a PAHub subject matter expert for customers throughout implementation, optimization, training, and ongoing support activities.
Participate in customer calls, workshops, business reviews, and operational meetings.
Develop trusted relationships with customer stakeholders by understanding their workflows, goals, challenges, and business requirements.
Advise customers on industry best practices and optimal use of PAHub functionality.
Identify opportunities to improve customer efficiency, automation, turnaround times, and overall satisfaction.
Proactively monitor customer adoption and recommend process improvements and workflow enhancements.

Product Demonstrations & Training

Conduct PAHub demonstrations for prospective and existing customers.
Showcase new features, product enhancements, and best practices.
Deliver customer training sessions tailored to different user roles and operational functions.
Assist customers in understanding how PAHub functionality supports their business and regulatory requirements.
Support onboarding activities for new customers and new customer team members.

Internal Team Support

Act as a resource for Account Management, Customer Success, Support, Implementation, Product, Training, and Operations teams.
Participate in internal customer strategy discussions and planning meetings.
Provide guidance on customer workflows, business requirements, and PAHub capabilities.
Help internal teams evaluate customer enhancement requests and identify potential solutions.
Share customer feedback, trends, and opportunities with Product Management and leadership teams.

Product Adoption & Optimization

Assess customer utilization of PAHub and identify opportunities for improvement.
Recommend workflow changes, configuration updates, and training opportunities to increase efficiency.
Help customers leverage existing functionality before pursuing custom development.
Support feature adoption initiatives and change management efforts.
Track customer challenges and coordinate with internal teams to ensure timely resolution.

Documentation & Knowledge Management

Partner with the Documentation and Training teams to create, review, and improve customer-facing materials.
Validate user guides, training materials, release communications, knowledge articles, and implementation documentation for accuracy and usability.
Assist in developing best practice guides, workflow examples, and process documentation.
Review customer communications to ensure clear and consistent messaging.

Voice of the Customer

Gather customer feedback and communicate key themes to Product, Engineering, and Leadership teams.
Advocate for customer needs while balancing product strategy and operational considerations.
Assist in prioritizing customer requests by providing business and workflow context.
Identify recurring customer questions and contribute to continuous improvements in training and documentation.

Required Qualifications

5+ years of experience in healthcare operations, prior authorization, utilization management, PBM, health plan operations, specialty pharmacy, or healthcare technology.
Hands-on experience with PAHub or a similar prior authorization platform.
Strong understanding of prior authorization workflows, operations, and regulatory requirements.
Experience working directly with customers in a consultative or client-facing capacity.
Excellent presentation, facilitation, and communication skills.
Ability to explain complex technical concepts to both technical and non-technical audiences.
Strong analytical and problem-solving abilities.
Ability to manage multiple priorities in a fast-paced, demanding environment with minimal supervision.
Maintain the strictest confidentiality in compliance with HIPAA guidelines.
Highly self-motivated, professional, take-charge attitude with humility and integrity.

Preferred Qualifications

Experience supporting SaaS healthcare applications.
Experience in training, customer success, account management, implementation, and/or consulting.
Knowledge of CMS, Medicaid, Medicare, and commercial utilization management processes.
Pharmacy Technician certification, pharmacist, or related healthcare credentials.
Experience creating documentation, training content, or knowledge management materials.

Success Measures

The PAHub & PA Specialist will be successful when:

Customers are effectively utilizing PAHub functionality and adopting new features.
Customer satisfaction and engagement levels improve.
Internal teams have access to timely, accurate product expertise.
Product demonstrations and training sessions are highly effective and well-received.
Documentation and customer-facing materials are accurate, useful, and easy to understand.
Customer feedback is translated into actionable improvements that enhance the overall customer experience.

This position offers a unique opportunity to influence customer success, product adoption, and the overall customer experience strategy while serving as a recognized PAHub expert across the organization.

Pay Range: Actual compensation will be determined based on the candidate's experience, qualifications, and work location. Candidates in different geographic markets may be offered compensation that reflects local market conditions.

Agadia Health Systems, Inc. is a leading healthcare management technology company addressing the evolving needs of the managed care market with a suite of utilization management solutions in electronic prior authorization, MTM, Part D star ratings & adherence, grievances, and formulary benefit design. Used by the nation’s largest health plans and PBMs, Agadia’s advanced technology solutions help drive operational efficiency, appropriate utilization, compliance, and profitability

Agadia is an Equal Opportunity Employer

Quick Apply

Refine Your Search

prior authorization specialist jobs in somerville, nj

PAHub & Prior Authorization Specialist

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

HEALTHCARE AUTHORIZATION / PRE-CERTIFICATION SPECIALIST

Medical Office Associate I, Full Time - 8am-4pm, Gastroenterology, Bridgewater

Central Scheduling Specialist - Per Diem

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

Surgical Scheduling Specialist - PMPH

Medical Billing Specialist ( on-site)

Medical Billing and Insurance Specialist

Medical Insurance Eligibility Specialist

Contact Center Representative

Prior Authorization Specialist

Patient Access Quality Specialist

Medical Office Associate I, Full Time - Days, Internal Medicine, Summit

Senior Revenue Cycle Billing Specialist - FT - Day - MSO/Centralized Billing Lawrenceville NJ

Front Office Specialist - Medication Management - Millburn, NJ

Medical Receptionist - Central NJ Locations

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

Pharmacy Technician FrameworkLTC Data Entry & Billing Specialist

Sr. Billing Specialist

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