Performance Ortho
Verification/Authorization Specialist
Performance Ortho, Bridgewater, Massachusetts, us, 02324
This range is provided by Performance Ortho. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $21.00/yr - $25.00/yr
Direct message the job poster from Performance Ortho
Human Resources Business Partner | Talent Acquisition Management | Candidate Experience | Employee Relations | Business Operations and Strategy | ATS… Location:
Performance Ortho Corporate Office (Bridgewater, NJ)
Employment Type:
Full-time, Hybrid 2 days remote
Schedule:
Monday – Friday
About Us
Performance Ortho is a leading provider of comprehensive orthopedic and outpatient care in New Jersey. With four clinic locations, an Ambulatory Surgery Center, and our corporate headquarters in Bridgewater, we’re celebrating 24 years of growth and excellence. Our holistic approach includes a wide array of services—Chiropractic, Physical Therapy, Acupuncture, Occupational Therapy, and Orthopedic Surgery—all aimed at delivering the highest quality of patient care. We pride ourselves on fostering a collaborative, supportive work environment where our team members are empowered to thrive and grow.
Job Overview
The Verification/Authorization Specialist is responsible for conducting detailed verification of patient eligibility and benefits, as well as securing required authorizations for services across government, commercial, and third‑party payers. This role ensures accurate and timely eligibility and authorization determinations while adhering to compliance regulations. The specialist will collaborate with internal teams, external vendors, and insurance providers to resolve discrepancies, streamline processes, and maintain data integrity.
A strong understanding of Medicare, Medicare Advantage, private insurance plans, and other third‑party payers is essential for success in this role.
Key Responsibilities
Eligibility & Verification
Conduct detailed reviews of patient insurance coverage, supporting documents, and eligibility criteria.
Verify patient insurance and benefit information for scheduled services, including diagnostics, therapies, and surgeries.
Process eligibility determinations in accordance with company policies and payer guidelines.
Authorizations
Obtain pre‑authorizations and referrals as required by insurance carriers.
Communicate with insurance representatives to ensure timely approval of procedures and services.
Track and follow up on pending authorizations to prevent delays in care.
Compliance & Quality Assurance
Ensure all verification and authorization activities align with company standards and regulatory requirements.
Conduct audits and quality checks to maintain accuracy and minimize errors.
Stay updated on payer policy changes and industry best practices.
Manage complex cases, including appeals, escalations, and exceptions.
Collaborate with internal departments—billing, scheduling, and clinical teams—to resolve insurance‑related issues.
Provide guidance and support to junior staff as needed.
Documentation & Reporting
Maintain accurate and up‑to‑date records in EHR and billing systems.
Prepare reports and summaries on verification and authorization trends.
Ensure compliance with HIPAA and internal confidentiality standards.
Respond to inquiries from patients, providers, and other stakeholders.
Clearly and professionally explain insurance coverage, eligibility status, and authorization outcomes.
Support the development of internal communication materials and policy updates.
Preferred Candidate Attributes
Exceptional attention to detail and accuracy
Strong analytical and problem‑solving skills
Excellent communication and customer service abilities
Ability to handle confidential information with discretion
Team‑oriented mindset with a proactive, solutions‑driven approach
Capable of managing multiple tasks and meeting deadlines in a fast‑paced environment
Qualifications
High school diploma or equivalent; Associate degree in healthcare administration or related field preferred
Minimum of 2 years of experience in verification, authorization, eligibility determination, or a related healthcare role
Familiarity with orthopedic billing codes, payer requirements, and insurance policies
Knowledge of EHR systems and billing software (eClinicalWorks experience preferred)
Proficiency in Microsoft Office Suite, especially Excel
Strong communication skills, both written and verbal
Ability to work independently and collaboratively within a team
Must be able to work onsite in Somerset County, NJ
Seniority level:
Not Applicable
Employment type:
Full‑time
Job function:
Administrative and Finance
Industries:
Hospitals and Health Care
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Base pay range $21.00/yr - $25.00/yr
Direct message the job poster from Performance Ortho
Human Resources Business Partner | Talent Acquisition Management | Candidate Experience | Employee Relations | Business Operations and Strategy | ATS… Location:
Performance Ortho Corporate Office (Bridgewater, NJ)
Employment Type:
Full-time, Hybrid 2 days remote
Schedule:
Monday – Friday
About Us
Performance Ortho is a leading provider of comprehensive orthopedic and outpatient care in New Jersey. With four clinic locations, an Ambulatory Surgery Center, and our corporate headquarters in Bridgewater, we’re celebrating 24 years of growth and excellence. Our holistic approach includes a wide array of services—Chiropractic, Physical Therapy, Acupuncture, Occupational Therapy, and Orthopedic Surgery—all aimed at delivering the highest quality of patient care. We pride ourselves on fostering a collaborative, supportive work environment where our team members are empowered to thrive and grow.
Job Overview
The Verification/Authorization Specialist is responsible for conducting detailed verification of patient eligibility and benefits, as well as securing required authorizations for services across government, commercial, and third‑party payers. This role ensures accurate and timely eligibility and authorization determinations while adhering to compliance regulations. The specialist will collaborate with internal teams, external vendors, and insurance providers to resolve discrepancies, streamline processes, and maintain data integrity.
A strong understanding of Medicare, Medicare Advantage, private insurance plans, and other third‑party payers is essential for success in this role.
Key Responsibilities
Eligibility & Verification
Conduct detailed reviews of patient insurance coverage, supporting documents, and eligibility criteria.
Verify patient insurance and benefit information for scheduled services, including diagnostics, therapies, and surgeries.
Process eligibility determinations in accordance with company policies and payer guidelines.
Authorizations
Obtain pre‑authorizations and referrals as required by insurance carriers.
Communicate with insurance representatives to ensure timely approval of procedures and services.
Track and follow up on pending authorizations to prevent delays in care.
Compliance & Quality Assurance
Ensure all verification and authorization activities align with company standards and regulatory requirements.
Conduct audits and quality checks to maintain accuracy and minimize errors.
Stay updated on payer policy changes and industry best practices.
Manage complex cases, including appeals, escalations, and exceptions.
Collaborate with internal departments—billing, scheduling, and clinical teams—to resolve insurance‑related issues.
Provide guidance and support to junior staff as needed.
Documentation & Reporting
Maintain accurate and up‑to‑date records in EHR and billing systems.
Prepare reports and summaries on verification and authorization trends.
Ensure compliance with HIPAA and internal confidentiality standards.
Respond to inquiries from patients, providers, and other stakeholders.
Clearly and professionally explain insurance coverage, eligibility status, and authorization outcomes.
Support the development of internal communication materials and policy updates.
Preferred Candidate Attributes
Exceptional attention to detail and accuracy
Strong analytical and problem‑solving skills
Excellent communication and customer service abilities
Ability to handle confidential information with discretion
Team‑oriented mindset with a proactive, solutions‑driven approach
Capable of managing multiple tasks and meeting deadlines in a fast‑paced environment
Qualifications
High school diploma or equivalent; Associate degree in healthcare administration or related field preferred
Minimum of 2 years of experience in verification, authorization, eligibility determination, or a related healthcare role
Familiarity with orthopedic billing codes, payer requirements, and insurance policies
Knowledge of EHR systems and billing software (eClinicalWorks experience preferred)
Proficiency in Microsoft Office Suite, especially Excel
Strong communication skills, both written and verbal
Ability to work independently and collaboratively within a team
Must be able to work onsite in Somerset County, NJ
Seniority level:
Not Applicable
Employment type:
Full‑time
Job function:
Administrative and Finance
Industries:
Hospitals and Health Care
#J-18808-Ljbffr