Prior Authorization Specialist

Job Description

Job Description

JOB DESCRIPTION

Insight Global's client is seeking a detail-oriented Prior Authorization Specialist to support a growing plastic and reconstructive surgery practice in Red Bank, NJ. This role is heavily focused on true prior authorization work, including initiating authorizations, tracking pending cases, following up with payers, supporting denial workflows, and ensuring documentation is complete and accurate for downstream billing and collections teams.

This person will support assigned physicians, manage authorization timelines tied to patient procedures, and work closely with surgical coordinators, providers, insurance carriers, and internal teams to help ensure services are approved prior to being performed. The ideal candidate is organized, proactive, timeline-driven, and comfortable working in a fast-paced healthcare environment where follow-through and attention to detail are critical.

Day-to-Day Responsibilities
-Initiate, track, and follow up on prior authorizations for scheduled procedures and medical services.
-Manage authorization work for assigned physicians, typically supporting approximately four doctors and initiating an average of three new authorizations per day, with the remainder of the workload focused on follow-ups, pending cases, audits, and documentation updates.
-Use insurance payer portals such as Availity and Navinet to verify benefits, submit authorization requests, check status updates, and document payer responses.
-Review patient insurance coverage and ensure all supporting documentation, medical records, and required forms are complete prior to submission.
-Follow up on pending authorizations based on urgency and procedure timing, with consistent updates to spreadsheets, notes, and internal tracking tools.
-Communicate authorization status, payer requirements, denials, trends, and urgent issues to surgical coordinators, physicians, and internal staff.
-Support denial workflows by notifying surgical coordinators, helping coordinate peer-to-peer reviews, tracking determinations, and assisting with appeal submissions when needed.
-Maintain clear, accurate, standardized documentation of all payer communications, provider interactions, follow-ups, and case updates.
-Prioritize cases based on patient procedure dates and urgency, including last-minute pending cases that may require strong ownership and follow-through.
-Maintain HIPAA compliance and protect patient and company confidentiality at all times.

Compensation:
$22 to $25 per hour.

Benefits:
-Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance
-401k and Profit sharing
-Paid Time Off
-Contribution to Health Benefits
-Company Discounts on Products & Services

REQUIRED SKILLS AND EXPERIENCE

- 2+ years of experience in a healthcare environment.
-Hands-on experience with prior authorizations, insurance verification, payer follow-up, referrals, denials, or related revenue cycle workflows.
-Experience using insurance portals, ideally Availity and/or Navinet.
-Strong understanding of medical terminology and general medical office procedures.
-Ability to communicate professionally with insurance representatives, providers, physicians, surgical coordinators, and internal staff.
-Strong attention to detail, organization, documentation accuracy, and ability to manage multiple pending cases at once.

NICE TO HAVE SKILLS AND EXPERIENCE

-Prior authorization experience within plastic surgery, radiology, or outpatient procedures.
-Experience working with out-of-network providers or gap exception requests.
-Experience supporting surgical or procedure-based authorization workflows.
-Familiarity with Blue Cross Blue Shield or other high-volume commercial payers.
-Experience supporting appeals, denials, peer-to-peer coordination, or medically necessary documentation requests.