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firstPROPhiladelphia
Prior Authorization Specialist
Career Insights for Medical Claims Processor / Representative
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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
We are seeking a detail-oriented Prior Authorization Specialist to join a growing healthcare organization on a temporary basis to support a maternity leave. This is an excellent opportunity for candidates with prior authorization, precertification, insurance verification, or utilization review experience who thrive in a fast-paced healthcare environment. While this is a temporary assignment, there is potential for a longer-term opportunity based on business needs. Looking to hire ASAP! Responsibilities Enter prior authorization and insurance approval information into the electronic medical record (EMR) system. Verify and document insurance authorizations for patient care and treatment. Collaborate with admissions, nursing, therapists, case managers, and billing staff to gather information needed for insurance approvals. Maintain accurate authorization records and patient documentation. Process and track insurance approvals while ensuring all required documentation is complete. Generate reports and assist with utilization review documentation. Support incoming admissions and insurance-related inquiries as needed. Ensure documentation complies with organizational policies and regulatory requirements. Provide additional administrative support to the Utilization Review department. Qualifications 2+ years of experience in prior authorization, precertification, insurance verification, utilization review, or healthcare administration . Experience working with Medicaid, Medicare, managed care, or commercial insurance plans. Strong data entry and documentation skills with exceptional attention to detail. Experience working with electronic medical records (EMR/EHR). Basic Microsoft Excel skills. Excellent organizational, communication, and problem-solving abilities. Ability to manage multiple priorities in a fast-paced environment. Preferred Qualifications Experience in behavioral health, mental health, addiction treatment, or substance abuse services. Familiarity with concurrent review or utilization management processes. Experience with NJSAMS or Streamline SmartCare is a plus. Why Apply? Competitive hourly pay. Monday through Friday daytime schedule. Opportunity to work with a respected healthcare organization. Potential for a longer-term opportunity based on business needs and organizational growth. If you have experience with prior authorizations, insurance verification, or precertification and are looking for your next opportunity, we'd love to hear from you. Apply today with your current resume!