Bilingual Pre-Authorization Specialist at Redefine Management, LLC – Matawan, New Jersey

At Redefine Healthcare, we believe in providing all patients with the highest quality of care and compassion. With our dedicated team of Neurosurgeons, Interventional Pain Management Specialists, Orthopedists, Psychiatrists, Physical Therapists, and Chiropractors, we pride ourselves on specializing in continuity of care for our patients. We are excited to add Vascular to our growing list of specialties.

Redefine Healthcare is looking for a dedicated, full-time Bilingual Pre-Authorization Specialist to join our expanding team of healthcare professionals in our Matawan Office. The Pre-Authorization Specialist will be responsible for obtaining, tracking, and securing prior authorizations for medical procedures, imaging studies, and treatments to ensure timely patient care and compliance with payer requirements. We are looking for candidates who are motivated, compassionate and are looking to advance their career in a community that is always growing.

Job Title: Bilingual Pre-Authorization Specialist

Pay Rate: $21-24/ hour, depending on specialty and experience

Hours: 40 hours per week

Job Type: Full- time

Benefits: Paid time off, sick time, health insurance (medical, dental, vision, accident, and critical illness), life insurance, 401(k) with Company match, yearly bonus

Job Title Duties (not limited to):

• Review provider orders and submit prior authorization requests to insurance companies.
• Track and follow up on pending authorizations to ensure timely approvals.
• Communicate authorization status to providers, patients, and clinical staff.
• Verify patient insurance coverage and benefits for requested services.
• Document authorization information in the patient’s medical record accurately and promptly.
• Resolve denied or delayed authorizations by coordinating with payers and providers.
• Maintain up-to-date knowledge of payer policies, clinical guidelines, and authorization requirements.
• Participate in ad hoc projects and perform additional duties as assigned.

Maintain Licensure or Certification:

• Certified Professional Coder (CPC), Certified Professional Biller (CPB), or related certification preferred.

Minimum Level of Education or Experience Required:

• High school diploma or equivalent required; associate’s degree in healthcare administration or related field preferred.
• Must be fluent in both English and Spanish, with the ability to communicate effectively in written and verbal form.
• Minimum of 2 years of experience in prior authorization, medical billing, or insurance verification.
• Knowledge of payer portals, authorization processes, and medical terminology.
• Strong communication and problem-solving skills.
• Proficiency in EMR/EHR systems and Microsoft Office applications.