Prior Authorization Specialist

1 week ago

West Long Branch, New Jersey, United States Sahni Rheumatology and Therapy Full time $48,960 - $98,400 per year

Sahni Rheumatology & Therapy is seeking an experienced and detail-oriented Prior Authorization Specialist with specific experience in biologic and specialty medications. The ideal candidate will have a strong understanding of the insurance authorization process, medical necessity documentation, and payer requirements for infusion and injectable biologic therapies.

Responsibilities:

  • Obtain prior authorizations for biologic medications through both medical and pharmacy benefits.
  • Review clinical documentation and ensure all necessary information is submitted to payers for approval.
  • Track, manage, and update the status of all authorization requests in a timely manner.
  • Follow up on denials, prepare appeals, and communicate with insurance companies to ensure timely resolution.
  • Collaborate closely with providers, biologic coordinators, and nursing staff to ensure patients receive treatment without delay.
  • Maintain accurate records of authorization requests, approvals, denials, and appeals.
  • Communicate regularly with patients when necessary to provide updates on authorization status or additional requirements.
  • Work with billing and administrative teams to ensure all services are billed accurately once authorizations are obtained.

Qualifications:

  • Minimum 2 years of experience in obtaining prior authorizations and managing referrals in a medical office, preferably in a rheumatology, infusion, or specialty practice.
  • Strong knowledge of insurance verification, payer policies, and biologic/specialty medication processes.
  • Excellent written and verbal communication skills.
  • Proficient in EMR systems and Microsoft Office applications.
  • Highly organized, detail-oriented, and able to manage multiple tasks efficiently.

Schedule:

  • Monday through Friday, 8:00 AM – 4:00 PM
  • No weekends or holidays

Compensation:

  • $23/hour
  • 401(k) eligibility after 1 year of employment

Job Type: Full-time

Pay: $ $23.00 per hour

Benefits:

  • 401(k)
  • Health insurance
  • Paid time off

Ability to Commute:

  • West Long Branch, NJ Required)

Ability to Relocate:

  • West Long Branch, NJ 07764: Relocate before starting work (Required)

Work Location: In person

  • Medical Billing Specialist

    2 weeks ago

    West Long Branch, New Jersey, United States Sahni Rheumatology and Therapy Full time $40,000 - $70,000 per year

    Perform posting charges and completion of claims to payers on timeObtain referrals and pre-authorizations as required for proceduresCheck eligibility and benefits verification for treatments, hospitalizations, and proceduresReview patient bills for accuracy and completeness, and obtain any missing informationPrepare, review, and transmit claims using billing...

  • Biologics Coordinator

    1 week ago

    West Long Branch, New Jersey, United States Sahni Rheumatology and Therapy Full time $144,000 - $182,000 per year

    About UsSahni Rheumatology and Therapy is a patient-focused medical practice specializing in the diagnosis and treatment of autoimmune and musculoskeletal disorders. We are committed to providing compassionate, evidence-based care, and are seeking a detail-oriented Biologic Coordinator to join our team.Position OverviewThe Biologic Coordinator plays a vital...

  • Medical Writer I/II

    7 days ago

    Long Branch, New Jersey, United States Parexel Full time

    When our values align, there's no limit to what we can achieve. At Parexel, we all share the same goal - to improve the world's health. From clinical trials to regulatory, consulting, and market access, every clinical development solution we provide is underpinned by something special - a deep conviction in what we do.Each of us, no matter what we do at...

  • Store Manager II- West Long Branch, NJ

    2 days ago

    West Long Branch, New Jersey, United States TD Full time

    Work Location:West Long Branch, New Jersey, États-Unis d'AmériqueHours40Pay Details$86,840 - $130,000 USDTD is committed to providing fair and equitable compensation opportunities to all colleagues. Growth opportunities and skill development are defining features of the colleague experience at TD. Our compensation policies and practices have been designed...

  • Pharmacist Specialist PD- Home Infusion

    1 week ago

    West Orange, New Jersey, United States RWJBarnabas Health Full time $80,000 - $120,000 per year

    Req #: Category: PharmacyStatus: Per DiemShift: DayDepartment: Home InfusionPay Range: $80.00 per hourLocation:95 OLD SHORT HILLS ROAD, WEST ORANGE, NJ 07052Job Title: Pharmacist Specialist PDLocation: Livingston Services CorpDepartment Name: Home InfusionReq #: Status: HourlyShift: DayPay Range: $ $80.00 per hourPay Transparency:The above reflects the...

  • Medical Receptionist

    3 days ago

    West Orange, New Jersey, United States THE NEPHROLOGY GROUP,PA Full time

    Full-Time Medical Office Position – Nephrology PracticeAn extremely busy, multi-physician Nephrology practice is seeking a dedicated and experienced professional to join our team full-time.Requirements:Minimum 1–2 years of medical office experienceBilingual (English/Spanish) – requiredProficient in EMR/EHR systemsSkilled in referrals, prior...

  • Certified Medical Assistant

    1 week ago

    West Orange, New Jersey, United States ADVOCARE, LLC Full time $45,000 - $65,000 per year

    :The Certified Medical Assistant is responsible for providing high quality direct patient care and assisting providers and other clinical staff with patient care and other clinical and administrative duties in a professional manner. Ability to competently and skillfully perform all clinical and clerical functions including, but not limited to: vital signs,...

  • Claim Specialist

    1 week ago

    Cortland West, New York, United States State Farm Full time $59,059 - $90,000

    OverviewBeing good neighbors – helping people, investing in our communities, and making the world a better place – is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a #1 team and do some goodGrow Your Skills, Grow Your PotentialResponsibilitiesJoin our team as a Property Field Inspection Claim...

  • Orthodontic Billing Specialist

    6 days ago

    West Babylon, New York, United States Babylon Dental Care Full time

    Benefits:401(k)401(k) matchingBonus based on performanceCompany partiesCompetitive salaryDental insuranceEmployee discountsFlexible scheduleHealth insuranceOpportunity for advancementPaid time offTraining & developmentTuition assistanceOrthodontic Billing Specialist"Treating people like family for over 42 years and creating an experience that exceeds an...

  • Billing Clerk

    1 week ago

    West Orange, New Jersey, United States Mental Health Association Full time $40,000 - $60,000 per year

    MHA promotes mental health and total wellness for individuals facing challenges associated with mental illness and addiction recovery. We increase community awareness while enhancing mental well-being through advocacy, education, prevention, treatment, and services. MHA is seekinga full time Administrative Assistant/ Billing Clerk to join our Community...