Prior Authorization Specialist - Continuum of Care - Full Time Day Shift (25384)

Join Our Team at New Bridge Medical Center!**

 We are dedicated to providing high-quality, compassionate care to our diverse community. As a leading healthcare provider, we offer a supportive and inclusive work environment. If you’re passionate about making a difference and thrive in a collaborative setting, New Bridge Medical Center is looking for a Prior Authorization Specialist.

Responsibilities:

• Complete medication and procedural prior authorizations through CoverMyMeds, payer portals such as Availity or Navinet, phone calls, and OTHER electronic systems.
• Communicate with insurance companies to clarify coverage requirements, criteria, and documentation needs.
• Collaborate with providers to gather and review clinical documentation for medical necessity and collect additional information required to obtain authorization.
• Communicate with patients regarding prior authorization updates, medication issues, or required documentation as needed.
• Track, follow up, and document all authorization statuses to ensure timely patient access to care.
• Assist providers and nurses with prior authorization related questions.
• Review denials, initiate appeals and submit supporting clinical notes to reverse decision as applicable.
• Maintain confidentiality and compliance with HIPAA and clinic policies.
• Other responsibilities as assigned that’s related to the department’s functions.

Position Qualifications:
2+ years of experience with prior authorizations or insurance verification strongly preferred.
Familiarity with EPIC preferred but not required
Familiarity with Medicare, Medicaid and Commercial authorization procedure preferred but not required.
Strong communication, problem-solving, and organizational skills.
Ability to work both independently and collaboratively within a clinical team.
Knowledge of medical terminology, medications, and insurance processes.

Education:
High School Diploma/ GED required.

$45,000 to $58,000 annually

We provide a comprehensive benefits package, including a competitive medical, dental, and vision plans.  We prioritize work-life balance with a generous time off policy that includes ample vacation days, personal time, sick leave and nine paid holidays.  Additionally, we are committed to the personal and professional growth of our employees, offering robust tuition reimbursement and continuing education programs to help support our employees ongoing development.