Remote Prior Authorization Specialist

Alliance-Orthopedics-; Bloomfield (NJ); Hybrid; USD 71,635,000 - 74,528,000; Full time

Benefits offered by this job

401(k) matching

Health insurance

Paid time off

Paid Holidays

Job summary

Alliance Health System is seeking an Authorizations Specialist to obtain prior authorizations for treatments, working remotely or in a hybrid setup. The role reports to the Director of Authorizations and requires familiarity with CPT/ICD-10 coding and payer guidelines.

Responsibilities include reviewing documentation, prioritizing requests, submitting authorizations, maintaining payer files, and initiating appeals when needed.

Qualifications

• Knowledge of treatment authorization and its impact on revenue cycle.
• Ability to apply payer guidelines to obtain authorizations.
• Proficiency with CPT and ICD-10 codes and payer portals.

Responsibilities

• Review chart documentation to ensure policy adherence.
• Prioritize authorization requests by urgency.
• Obtain authorizations via payer portals, fax or phone and follow up.
• Maintain payer files with up-to-date requirements.
• Initiate appeals for denials or modifications.
• Answer clinic questions on payer medical policies; validate CPT/ICD-10 accuracy.
• Perform other duties as assigned.

Skills

CPT codes

ICD-10 codes

Payer guidelines

Excel

Customer service

Time management

Attention to detail

Education

High School Diploma or GED

2 years medical prior authorization experience

2 years MD provider experience - Orthopedics & Pain

Tools

Adobe Acrobat

Job description

Alliance Health System is seeking an Authorizations Specialist to obtain prior authorizations for treatments, working remotely or in a hybrid setup. The role reports to the Director of Authorizations and requires familiarity with CPT/ICD-10 coding and payer guidelines.

Responsibilities include reviewing documentation, prioritizing requests, submitting authorizations, maintaining payer files, and initiating appeals when needed.