Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Rev Cycle Specialist (Prior Authorizations)

PRISM Vision Group

Role and Responsibilities :

  • Identifies all appointments and procedures that require prior-authorization by monitoring system reports
  • Reviews patient diagnoses and medical notes/laboratory reports required for prior-authorizations submissions
  • Accountable for knowledge of updated drug and procedure prior-authorization requirements, relating to all commercial insurance carriers
  • Communicates with Insurance carriers by phone for cases of urgency, down systems, research/clarifications or troubleshooting
  • Independently maintains and updates multiple reports on all upcoming patient appointments and prior-authorizations
  • Maintains patient confidentiality
  • Utilizes insurance portals to submit prior-authorizations
  • Troubleshoots prior-authorization cases for insurances
  • Manages a high-volume demand for prior-authorizations with accuracy
  • Attends and participates in NJ Retina / or payer meetings/seminars as needed
  • Maintains open, positive cordial, team-oriented lines of communications with managers and staff members
  • Contributes to the Business office team thought, positive attitude, respectful interaction, innovative ideas and efficiently
  • Other duties as assigned
Essential Qualifications :

Education: High School Diploma or equivalent; Bachelor’s degree preferred.

Experience: 1+ years’ experience in an administrative role; medical billing experience within Ophthalmology preferred but not required.

Knowledge/Skills/Experience :
  • Working knowledge of prior-authorization process
  • Experience with Medicare, insurances, claims, appeals
  • Knowledge of CPT, ICD-9 and/or ICD-10 codes a plus
  • Proven customer service skills
  • Able to work in a high volume/fast-paced environment
  • Excellent written and verbal communication skills
  • Outstanding attention to detail and excellent time management skills
  • Outstanding typing and computer skills with billing software, Microsoft Word and Microsoft Excel
  • Ability to work with sensitive and confidential information
Hourly Pay Range-
$21.8500 to $25.00 USD

At PRISM Vision Group, we believe great work deserves great rewards. Here’s what you can expect when you join our team:
  • Competitive Compensation – Base salary, performance bonuses, and regular reviews.
  • Health & Wellness – Comprehensive medical, dental, and vision insurance; and wellness program.
  • Retirement Planning – 401(k) with company match.
  • Generous Time Off – Paid vacation, sick leave, and company holidays.
  • Learning & Development –career growth programs.
  • Other Perks – Commuter benefits, Voluntary Accident and Critical Illness plans, FSA/HSA and Dependent Care FSA. employee discounts, and more.

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.
Vacancy posted 5 days ago
Similar jobs that could be interesting for youBased on the Rev Cycle Specialist (Prior Authorizations) in New Providence, NJ vacancy
  •  ...Rev Cycle Specialist (Prior Authorizations) Role and Responsibilities: Identifies all appointments and procedures that require prior-authorization by monitoring system reports Reviews patient diagnoses and medical notes/laboratory reports required for prior... 
    Suggested
    Hourly pay
    Work at office

    PRISM Vision Group

    Berkeley Heights, NJ
    2 days ago
  • $21.38 - $44.4 per hour

     ....38-$44.40/hr (Dependent on Experience) The Revenue Cycle Specialist is responsible for billing and collecting from their assigned...  ...School Diploma or General Education Degree (GED) with 3 years prior hands-on experience in a fast-paced medical billing... 
    Suggested

    The US Oncology Network

    New Providence, NJ
    9 days ago
  • $23 - $25 per hour

     ...Rev Cycle Specialist (COPAY ASSIS SPECIALIST) The Revenue Cycle Specialist is responsible for a variety of duties, including but not limited to Accounts Receivable. Essential Qualifications: Education: High School Diploma or equivalent; Bachelor's degree preferred... 
    Suggested
    Hourly pay

    PRISM Vision Group

    Berkeley Heights, NJ
    6 days ago
  • Hospital Appeals Specialist (RN) Full Time, Days 7a-3p, Morristown, NJ. Job Description...  ...medical claims denials in the Revenue Cycle Integrity department. Denial Review &...  ...for medical necessity, level of care, prior authorization, and diagnosis‑related group... 
    Suggested
    Full time
    Temporary work
    Part time
    For contractors
    For subcontractor
    Flexible hours

    Atlantic Health System

    Convent Station, NJ
    5 days ago
  • $16.56 - $25 per hour

     ...Patient Eligibility Specialist As a key contributor to clinical and revenue cycle operations, a Patient Eligibility Specialist...  ...necessary referrals, authorizations, and pre-certifications to mitigate...  ...deductibles, and co-insurance. Prior Authorization: Efficiently... 
    Suggested
    Hourly pay
    Work at office

    PRISM Vision Group

    Berkeley Heights, NJ
    5 days ago
  • $24 - $36 per hour

     ...Insurance Follow-Up Specialist – Oral Surgery – Salary: $24–$36 per hour. Responsibilities Resolve billing discrepancies and claim denials...  ...and provide feedback to management. Work with internal revenue cycle and administrative teams to identify and manage third‑party... 
    Hourly pay
    Work at office

    Max Surgical Specialty Management

    Parsippany, NJ
    4 days ago
  • $27 - $33 per hour

     ...motivated and dynamic individual to join our Revenue Cycle Management Team as a Revenue Cycle Specialist-Full Cycle Management . What You'll Do:...  ...discrepancies -Manage claim denials related to authorization, medical record Patient Billing & Collections:... 
    Work at office

    Max Surgical Specialty Management

    Parsippany, NJ
    2 days ago
  • Cycling Specialist - Hilltop Bicycles - Cranford, NJ A critical member of the team, the Cycling Specialist balances a passion for people and excellence in retail. The Specialist is front line and point person for the store, working directly with riders, both present and... 
    Temporary work
    Remote work

    Specialized Retail East Coast LLC

    Cranford, NJ
    5 days ago
  • Specialized Retail East Coast LLC is seeking a Cycling Specialist for their Cranford, NJ location. This role is vital in delivering exceptional...  .... Ideal candidates will have a passion for cycling and prior retail experience, along with excellent communication skills.... 

    Specialized Retail East Coast LLC

    Cranford, NJ
    5 days ago
  •  ...Analysis Review payer denials (medical necessity, level of care, authorization, DRG downgrades) Analyze medical records against criteria...  ...~ Medical Record Audits ~ Denials/Appeals or Revenue Cycle About Us At Atlantic Health, our promise to our communities... 
    Hourly pay
    Full time
    Temporary work
    Part time
    For contractors
    For subcontractor
    Flexible hours
    Shift work
    Day shift

    Atlantic Health System

    Morristown, NJ
    3 days ago
  •  ...Reimbursement Specialist PromptCare seeks a highly motivated, experienced, and detail...  ...insurance data collection, verification, and authorization. Documentation and computer input of...  ...on all aspects of the revenue cycle related to reimbursement, including projects... 
    Full time
    Temporary work
    Work at office
    Local area
    Monday to Friday
    Flexible hours
    Early shift

    Prompt Care of Central Florida

    New Providence, NJ
    12 days ago
  • $56.95k - $95k

     ...Specialist, US Payroll and People Operations Location: Berkeley Heights...  ...the Leave team Process off‑cycle payrolls, retroactive adjustments...  ..., and approvals prior to payroll submission Identify...  ...functionally without direct authority Compensation Base Salary: $56... 
    Full time
    Local area

    Hikma Pharmaceuticals

    Berkeley Heights, NJ
    6 hours ago
  • $70.5k - $94.4k

     ...housing availability/options. The Housing Specialist(s) shall act as the Contractors central...  ...voucher programs, public housing authorities, realtors, and online housing locator resources...  ...a strong background in processing prior authorizations and show proven expertise... 
    Full time
    For contractors
    Work experience placement
    Live in
    Work at office
    Local area

    Horizon Blue Cross Blue Shield of New Jersey

    Parsippany Troy Hills, NJ
    4 days ago
  • $50.48 per hour

     ...Position Summary The Veeva RIM Specialist will provide expertise and...  ...conformance with Health Authority requirements. This role is hands...  ...the upload, tracking, life cycle maintenance of regulatory submissions...  ...candidate's qualifications, prior experience as well as... 
    Hourly pay
    Temporary work
    Monday to Friday
    Flexible hours

    ImmunityBio

    Summit, NJ
    2 days ago
  • $20 - $25 per hour

     ...Overview We are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our team. This role is crucial in ensuring that patients receive the necessary medical services and treatments by obtaining prior authorizations from insurance companies... 
    Hourly pay
    Full time
    Work at office
    Relocation

    NJ PEDIATRIC NEUROSCIENCE INSTITUTE

    Convent Station, NJ
    4 days ago
  •  ...Associate Specialist, Quality Product Release-Disposition 100% onsite Work Schedule: 11 am to 7:30 pm - Mon-Fri Position Title: Associate Specialist, Quality Product Release-Disposition Location: Summit West, S-12 PURPOSE AND SCOPE OF POSITION: The Associate Specialist... 
    Work at office

    TechDigital Group

    Summit, NJ
    6 hours ago
  • Sterling Therapy Providers in Mountainside, New Jersey is looking for an Occupational Therapist. The role involves conducting occupational therapy programs to facilitate rehabilitation and engaging residents in activities that enhance their performance and adaptability...

    Sterling Therapy Providers

    Mountainside, NJ
    1 day ago
  • A leading healthcare provider in New Providence is seeking a Full-Time Physical Therapist. The role involves conducting patient evaluations, developing treatment plans, and collaborating with interdisciplinary teams. The ideal candidate will hold a New Jersey license and...
    Full time

    Atlantic Health System

    New Providence, NJ
    6 hours ago
  • Berkeley Heights Public Schools is seeking a Maintenance employee to oversee the overall operation of school buildings and grounds. The ideal candidate will have a high school diploma and experience in custodial services, mechanical repairs, and general maintenance techniques...

    Berkeley Heights Public Schools

    Berkeley Heights, NJ
    4 days ago
  •  ...PHARMACOVIGILANCE SPECIALIST job at System One. Madison, NJ. Job Title : Pharmacovigilance Specialist Location : Lawrenceville, NJ Hours/Schedule: Hybrid 50% onsite Type: Contract Responsibilities Build and continuously improve data analytics through supporting models... 
    Contract work
    Local area

    kozmetickesluzby.vecnakraska.sk - Jobboard

    Madison, NJ
    4 days ago
  • $55 - $58.74 per hour

    Bristol Myers Squibb is seeking a Data Analyst in Madison, New Jersey, to enhance data analytics and reporting. The candidate will develop and maintain reporting databases in tools like SAP Business Objects, Tableau, and Power BI, contributing to efficiency and key performance...
    Hourly pay
    Monday to Friday

    Bristol-Myers Squibb

    Madison, NJ
    4 days ago
  • $55 - $58.74 per hour

    Responsibilities Data Analytics and Reporting Build and continuously improve data analytics through supporting models that provide insights into efficiency, quality, stakeholder feedback, and key performance indicators to drive timely and informed decision making Maintain...
    Hourly pay
    Flexible hours

    Bristol-Myers Squibb

    Madison, NJ
    4 days ago
  •  ...Thimble Alterations is seeking a skilled wedding dress specialist to join our network of independent alteration professionals. This role involves hem and fit adjustments for various wedding dress silhouettes and requires experience with delicate fabrics. Ideal candidates... 
    For contractors
    Work from home

    Thimble Alterations

    New Providence, NJ
    6 hours ago
  •  ...Minimum 50% onsite required The Specialist works cross-functionally to execute validation activities and prepare validation deliverables...  ..., such as CSV SOP but not limited to applicable health authority regulations. REQUIRED COMPETENCIES: Knowledge, Skills, and Abilities... 
    Work experience placement

    TechDigital Group

    Summit, NJ
    4 days ago
  •  ...Endoscopy OnSite Specialist Work Flexibility: Field-based As an Endoscopy OnSite Specialist, you will play an essential role in supporting surgical teams and ensuring that equipment, processes, and information flow smoothly to help drive exceptional patient care... 
    Hourly pay
    For contractors
    Work experience placement
    Work at office
    Flexible hours
    Night shift
    Weekend work

    Stryker

    Summit, NJ
    1 day ago
  •  ...About the Role We are seeking a detail-oriented Order-to-Cash (O2C) Specialist to support and optimize the full cycle of customer transactions—from order placement to payment collection. This position plays a key role in ensuring accurate processing, billing, and reporting... 

    ROSA CLARÁ GROUP

    West Caldwell, NJ
    6 hours ago
  • $15 - $20 per hour

    Compensation Pay Range: $15.00 - $20.00 per hour. Hourly rate will equal or exceed the local minimum wage. Additional compensation includes annual, quarterly performance bonuses or premium pay based on schedule, facility, season, or specific work performed. Multiple premiums...
    Hourly pay
    Minimum wage
    Local area
    Immediate start

    O'Reilly Auto Enterprises, LLC

    Westfield, NJ
    4 days ago
  • $17.75 - $21.75 per hour

     ...departments as needed. Maintain regular, predictable, full attendance. Qualifications Work experience in a deli department preferred. Prior experience operating manual/power slicers and scales preferred. Knowledge of deli products preferred. At least 18 years of age.... 
    Hourly pay
    Weekly pay
    Work experience placement
    Flexible hours

    BJ's Wholesale Club

    Fanwood, NJ
    4 days ago
  • Overview At the direction of the Sr. Manager of Plant and Facilities, support all corporate facilities and its equipment including HVAC, CD Air and test gas compressors, basic electrical work, high pressure plumbing, basic plumbing, basic construction, and perform special...
    For contractors
    Local area

    Valcor Engineering Corporation

    Springfield, NJ
    4 days ago
  •  ...Children's Wisconsin is seeking a Profee Surgical Coding Specialist III for a remote position. This role focuses on Pediatric Urology and ENT coding, requiring at least 3 years of Profee coding experience. Candidates should be knowledgeable of ICD10, CPT, and HCPCS coding... 
    Remote work

    Children's Wisconsin

    Summit, NJ
    2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Rev Cycle Specialist (Prior Authorizations). Be the first to apply!