Prior Authorization Specialist – Continuum of Care (Day Shift)

Care Plus Bergen, Inc.; Paramus (NJ); On-site; USD 45,000 - 58,000; Full time

Benefits offered by this job

Medical insurance

Dental plan

Vision plan

Paid time off

Holidays

Tuition reimbursement

Continuing education

Job summary

Bergen New Bridge Medical Center in Paramus, NJ is seeking a dedicated Prior Authorization Specialist to join our Continuum of Care team. This full-time, day-shift role focuses on obtaining timely authorizations through CoverMyMeds and payer portals, while coordinating with providers and patients to gather necessary documentation.

The ideal candidate has 2+ years of relevant experience, familiarity with EPIC, and strong communication skills.

Qualifications

• 2+ years of experience with prior authorizations or insurance verification.
• Familiarity with EPIC preferred but not required.
• Familiarity with Medicare, Medicaid and Commercial authorization procedures 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.

Responsibilities

• Complete prior authorizations via CoverMyMeds, payer portals such as Availity or Navinet, 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 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 decisions as applicable.
• Maintain confidentiality and compliance with HIPAA and clinic policies.
• Other responsibilities as assigned.

Skills

Strong communication

Problem-solving

Organizational skills

Independent yet collaborative

Education

High School Diploma/GED

Tools

EPIC

CoverMyMeds

Availity

Navinet

Job description

Bergen New Bridge Medical Center in Paramus, NJ is seeking a dedicated Prior Authorization Specialist to join our Continuum of Care team. This full-time, day-shift role focuses on obtaining timely authorizations through CoverMyMeds and payer portals, while coordinating with providers and patients to gather necessary documentation.

The ideal candidate has 2+ years of relevant experience, familiarity with EPIC, and strong communication skills.