Prior Authorization Specialist - Continuum of Care - Full Time Day Shift (25384)

About the role

Join Our Team at Bergen New Bridge Medical Center! We are dedicated to providing high-quality, compassionate care to our diverse community. As a leading healthcare provider, we offer a supportive and inclusive work environment. If you’re passionate about making a difference and thrive in a collaborative setting, Bergen New Bridge Medical Center is looking for a Prior Authorization Specialist.

Responsibilities

• Complete medication and procedural prior authorizations through CoverMyMeds, payer portals such as Availity or Navinet, phone calls, and OTHER electronic systems.
• Communicate with insurance companies to clarify coverage requirements, criteria, and documentation needs.
• Collaborate with providers to gather and review clinical documentation for medical necessity and collect additional information required to obtain authorization.
• Communicate with patients regarding prior authorization updates, medication issues, or required documentation as needed.
• Track, follow up, and document all authorization statuses to ensure timely patient access to care.
• Assist providers and nurses with prior authorization related questions.
• Review denials, initiate appeals and submit supporting clinical notes to reverse decision as applicable.
• Maintain confidentiality and compliance with HIPAA and clinic policies.
• Other responsibilities as assigned that’s related to the department’s functions.

Requirements

• 2+ years of experience with prior authorizations or insurance verification strongly preferred.
• Familiarity with EPIC preferred but not required.
• Familiarity with Medicare, Medicaid and Commercial authorization procedure preferred but not required.
• Strong communication, problem-solving, and organizational skills.
• Ability to work both independently and collaboratively within a clinical team.
• Knowledge of medical terminology, medications, and insurance processes.
• High School Diploma/GED required.

Pay

Salary commensurate with experience within posted range: $45,000 to $58,000 annually.

Benefits

• Comprehensive benefits package including competitive medical, dental, and vision plans.
• Generous time off policy with ample vacation days, personal time, sick leave, and nine paid holidays.
• Robust tuition reimbursement and continuing education programs for personal and professional growth.