Senior Prior Authorization / Patient Insurance Specialist in Madison, New Jersey at Madison Medical and Sports Rehabilitation Center

Senior Prior Authorization Specialist / Patient Insurance Liaison
Location: Madison, NJ (on-site)
Employment Type: Full-time
Pay Range: $67,000-$70,000 annually commensurate with experience, OON/MSK depth, and payer-portal command.

About Madison Medical Sports & Wellness
Madison Medical Sports & Wellness is a New Jersey state-licensed, multi-specialty ambulatory care facility operating 15+ integrated service lines, including chiropractic, physical therapy, pain management, sports medicine, podiatry, regenerative medicine, hormone optimization, weight management, IV therapy, allergy/SLIT, acupuncture, sleep studies, and our Athletic Recovery Center.
Position Summary
We are seeking a seasoned, highly organized Prior Authorization / Patient Insurance Liaison Specialist who lives and breathes payer rules. This is not an entry-level role. The ideal candidate has worked the full spectrum — out-of-network commercial, in-network commercial, Medicare, Medicaid, hybrid plans, and cash/self-pay — and can move authorizations and benefit determinations across all of them independently. You read a denial and already know the appeal angle, you understand musculoskeletal (MSK) clinical workflows, and you know the documentation each payer requires to approve them.
What You'll Own

End-to-end prior authorizations: submit, track, and secure approvals across all payer types and all 15+ service lines, with MSK and orthopedic/spine workflows front and center.
Out-of-network (OON) strategy: verify OON benefits, calculate patient responsibility, and manage gap exceptions, single-case agreements, and OON authorization pathways.
Patient insurance liaison: serve as the clear, calm voice explaining coverage, benefits, deductibles, and out-of-pocket costs across every plan type accepted.
Benefit verification: run accurate eligibility and benefits checks for commercial, Medicare, Medicaid, hybrid, and cash patients before care is rendered.
Denials and appeals: identify root cause, build clean appeal packets, and overturn denials with payer-specific documentation.
Payer portal mastery: Availity, NaviNet, UnitedHealthcare, Horizon BCBS, Cigna, Aetna, CMS/Medicare, NJ Medicaid (NJ FamilyCare), and others.
Technology and AI: leverage EMR, RCM, and AI-assisted authorization tools to reduce turnaround time and keep documentation airtight.

Required Experience (Non-Negotiable)

5–8 years of hands-on prior authorization / insurance verification experience in a clinical or RCM setting.
Proven out-of-network (OON) experience: actively worked OON benefits, gap exceptions, and patient-responsibility calculations — not in-network only.
MSK / musculoskeletal specialty experience: orthopedics, spine, pain management, PT, chiropractic, or sports medicine authorization workflows.
Demonstrated command of all payer types: commercial (in- and out-of-network), Medicare, Medicaid, hybrid plans, and cash/self-pay.
Payer-portal expertise: fast and fluent across major commercial and government portals.
Technology- and AI-forward: comfortable adopting new systems and AI-assisted tools, with strong EMR proficiency.
Exceptionally organized: tracks every case, never lets an authorization lapse, and documents thoroughly.

Preferred / Bonus

Experience with Oracle Health, CureMD, or comparable enterprise EMRs.
Familiarity with UB-04 institutional billing and multi-specialty fee schedules.
CPC, CPB, or prior-authorization certification.
Multi-site or high-volume ambulatory experience.

Why Madison Medical

Growth, not maintenance: we are actively expanding service lines, launching new programs, and adding providers. Your work directly drives revenue.
Modern stack: Oracle Health EMR, AI-assisted authorization tooling, and real RCM infrastructure.
Real ownership: you'll be the authority on authorizations across 15+ specialties, with leadership that values the function.