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

Care Plus Bergen, Inc.; Paramus (NJ); In loco; USD 45.000 - 58.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical insurance

Dental plan

Vision plan

Paid time off

Holidays

Tuition reimbursement

Continuing education

Descrizione del lavoro

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.

Competenze

• 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.

Mansioni

• 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.

Conoscenze

Strong communication

Problem-solving

Organizational skills

Independent yet collaborative

Formazione

High School Diploma/GED

Strumenti

EPIC

CoverMyMeds

Availity

Navinet

Descrizione del lavoro

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

Job Category: Business Office/Clerical

Requisition Number: PRIOR009619

• Posted : October 15, 2026
• Full-Time

Locations

Showing 1 location

New Jersey CPB
Paramus, NJ 07652, USA

Description

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.

Position Qualifications

• 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.

Education

• High School Diploma/ GED required.

Salary

Salary commensurate with experience within posted range:

$45,000 to $58,000 annually

Benefits

We provide a comprehensive benefits package, including a competitive medical, dental, and vision plans. We prioritize work-life balance with a generous time off policy that includes ample vacation days, personal time, sick leave and nine paid holidays. Additionally, we are committed to the personal and professional growth of our employees, offering robust tuition reimbursement and continuing education programs to help support our employees ongoing development.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.