Prior Authorization Specialist

Job Description

Job Description

Job Title: Prior Authorization Specialist
Job Description

This role focuses on managing a high volume of prior authorizations and insurance-related tasks while delivering excellent patient service in a busy medical office. The Prior Authorization Specialist supports both front-office and clinical workflows, ensuring patients feel welcomed, informed, and efficiently guided through their visits. This position requires strong attention to detail, solid insurance knowledge, and the ability to work collaboratively with healthcare providers and administrative staff.

Responsibilities

• Handle a high volume of prior authorizations for procedures and medications, ensuring timely and accurate approvals.
• Utilize ModMed as the electronic medical record (EMR) system to maintain and update patient records accurately and securely.
• Welcome patients as they arrive, ensuring they feel comfortable, informed, and supported throughout their visit.
• Authorize procedures and medications in accordance with insurance requirements and practice protocols.
• Obtain and verify patient benefits and eligibility for various insurance plans.
• Manage the appointment calendar, schedule patient visits, and coordinate with medical staff availability to maintain efficient patient flow.
• Handle incoming calls, route them to appropriate personnel, and address patient inquiries in a professional and courteous manner.
• Verify patient insurance coverage prior to visits and collect applicable copayments and account balances at the time of service.
• Assist patients with check-in and check-out procedures, ensuring all necessary forms and documentation are completed accurately.
• Maintain and update patient records, including demographics and insurance information, ensuring confidentiality and data integrity.
• Process insurance claims, create invoices, and support patient billing activities as needed.
• Assist with patient examinations by taking vital signs and preparing patients for procedures when required.
• Update and maintain accurate patient medical histories and clinical documentation within the EMR.
• Provide patients with clear information on treatments, medications, and post-procedure care instructions as directed by healthcare providers.
• Order and manage medical supplies and equipment to ensure the office remains well stocked and prepared for daily operations.
• Collaborate with healthcare providers and office staff to ensure smooth patient flow and efficient office operations.
• Perform data entry of basic demographic and insurance information with a high level of accuracy.
• Confirm eligibility for various patient insurance plans and obtain referrals as needed to support scheduled services.
• Deliver consistent, high-quality customer service to patients, payers, and internal team members.

• Recent prior authorization experience, specifically handling authorizations for procedures and medications.
• Strong knowledge of insurance plans, benefits, eligibility verification, and referral requirements.
• Proficiency using electronic medical records (EMR), with experience in ModMed preferred.
• Experience in insurance verification and confirming patient eligibility.
• Ability to manage patient care workflows, including check-in, check-out, and coordination of appointments.
• Customer service skills with the ability to communicate clearly and professionally with patients and staff.
• Experience in healthcare or medical office settings, including familiarity with patient billing and claims processing.
• Strong data entry skills with attention to detail and accuracy.
• Ability to support patient examinations, including taking vital signs and preparing patients for procedures.
• Organizational skills to manage multiple tasks such as scheduling, authorizations, and documentation simultaneously.

• Experience with surgical scheduling is highly valued.
• Prior experience in a multi-office or large network medical practice is beneficial.
• Comfort working in a fast-paced environment with a high volume of insurance and prior authorization tasks.
• Ability to build positive relationships with patients and colleagues, contributing to a supportive team culture.
• Flexibility to work occasional weekend shifts as part of the regular schedule.
• Interest in long-term employment with opportunities to grow within a large, multi-site practice.
• General understanding of healthcare workflows, including coordination between front office and clinical staff.

This position is based in the Sparta office within a larger network of seven local New Jersey offices, offering a small-group feel within a broader organization. The practice employs over 80 team members across multiple locations, providing exposure to a wide range of skill sets and responsibilities. The standard schedule is Monday through Friday, day shift, with start times typically between 7:15 a.m. and 8:00 a.m., working either 7:30 a.m.–3:30 p.m. or 8:00 a.m.–4:00 p.m. Approximately four to five times per year, you will work a Saturday and Sunday shift from 8:00 a.m. to 12:00 p.m., with one weekday off in exchange. The role involves regular use of EMR systems, particularly ModMed, along with phones, computers, and standard office and medical equipment. The environment emphasizes teamwork, positive culture, and strong communication, with consultants consistently reporting positive feedback about the workplace. Benefits for permanent employees include a 401(k) with match, generous paid time off packages, and regular bonding activities such as a yearly company party, fostering a collaborative and supportive atmosphere.

Job Type & Location

This is a Contract to Hire position based out of Wharton, NJ.

The pay range for this position is $18.00 - $21.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully onsite position in Wharton,NJ.

This position is anticipated to close on May 25, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email [email protected] for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.