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MO
Medical Offie
Prior Authorization Specialist
Career Insights for Medical Claims Processor / Representative
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Scorecard
Based on New Jersey data
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What they do
A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
$49,093 / year median in New Jersey
-5% projected decline
Job Description
Job Summary for
Proven experience in a medical office or healthcare setting, with familiarity in medical records management and office procedures. Strong knowledge of health insurance policies, managed care processes, and insurance verification procedures. Proficiency in medical coding including CPT, ICD-10, and ICD coding systems. Experience working with electronic health records (EHR) or electronic medical records (EMR) systems; familiarity with EHR/EHR management is preferred. Excellent customer service skills with the ability to communicate clearly and professionally across diverse audiences. Knowledge of clinical confidentiality policies such as HIPAA to protect patient privacy at all times. Competency in Microsoft Office applications for documentation and communication purposes. Ability to handle multiple tasks efficiently while maintaining attention to detail in a fast-paced environment. Ideal Candidate Someone with experience in Pain Management, surgical scheduling, prior authorizations, ASC/hospital operations, or insurance who understands
Surgical Coordinator & Prior Authorization Specialist:
This role is responsible for coordinating pain management procedures from scheduling through completion , while ensuring that all insurance authorizations, documentation, and payer requirements are properly handled.Main responsibilities:
Obtain prior authorizations for office procedures and surgeries, including same-day requests. Verify insurance requirements for commercial insurance, NJ PIP, auto accident, and workers' compensation . Work with payer portals such as Availity, UHC, Novitas, Cohere, TurningPoint, eVicore/MedSolutions, and Genzeon . Handle authorization denials, missing information, discrepancies, and peer-to-peer requests . Schedule surgeries at ASCs and hospitals , including OR time and facility dates. Prepare and submit surgical booking sheets and ensure all procedure details are accurate. Coordinate device/implant representatives, co-surgeons, and assistant surgeons when needed. Communicate cancellations, rescheduling, and changes between providers, facilities, patients, and office staff. Track cases from initial scheduling through completion , making sure authorization and documentation are in place. Use eClinicalWorks (eCW) to document authorizations, surgical information, insurance details, and payer communications. Work closely with billing to address authorization-related denials and support appeals.Proven experience in a medical office or healthcare setting, with familiarity in medical records management and office procedures. Strong knowledge of health insurance policies, managed care processes, and insurance verification procedures. Proficiency in medical coding including CPT, ICD-10, and ICD coding systems. Experience working with electronic health records (EHR) or electronic medical records (EMR) systems; familiarity with EHR/EHR management is preferred. Excellent customer service skills with the ability to communicate clearly and professionally across diverse audiences. Knowledge of clinical confidentiality policies such as HIPAA to protect patient privacy at all times. Competency in Microsoft Office applications for documentation and communication purposes. Ability to handle multiple tasks efficiently while maintaining attention to detail in a fast-paced environment. Ideal Candidate Someone with experience in Pain Management, surgical scheduling, prior authorizations, ASC/hospital operations, or insurance who understands