Healthcare Prior-Authorization Specialist

Summit Health Management; Fair Lawn (NJ); On-site; USD 55,000 - 75,000; Full time

Job summary

Summit Health Management is seeking an Authorization Specialist in New Jersey to obtain authorizations for surgical procedures, testing, medications, DME, and referrals as part of Revenue Cycle. You will verify benefits, prepare documentation, and communicate with patients and physicians to minimize denials.

Ideal candidates have high school diploma and 2–4 years of related experience, with strong knowledge of Epic and insurance policies, ensuring accurate and timely authorizations.

Qualifications

• Expertise in selecting correct insurance packages within Epic.
• Experience obtaining authorizations for procedures and referrals.
• Ability to verify eligibility and benefits accurately.
• Clear communication with patients, physicians and staff.

Responsibilities

• Identifies appointments and procedures requiring authorization by monitoring schedules and reports.
• Determines referral and authorization requirements per insurance guidelines.
• Verifies insurance eligibility and updates patient information.
• Completes referrals and prior authorizations timely per workflows.
• Resolves issues to prevent denials and communicates with team.

Skills

Epic knowledge

Authorization experience

Insurance verification

Communication skills

Documentation gathering

Education

High School Diploma or GED

Job description

Summit Health Management is seeking an Authorization Specialist in New Jersey to obtain authorizations for surgical procedures, testing, medications, DME, and referrals as part of Revenue Cycle. You will verify benefits, prepare documentation, and communicate with patients and physicians to minimize denials.

Ideal candidates have high school diploma and 2–4 years of related experience, with strong knowledge of Epic and insurance policies, ensuring accurate and timely authorizations.