Verification/Authorization Specialist

Job Title: Verification/Authorization SpecialistLocation: Performance Ortho Corporate Office (Bridgewater, NJ)Employment Type: Full-time, Hybrid 2 days remoteSchedule: Monday – FridayAbout UsPerformance 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 25 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 OverviewThe 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 ResponsibilitiesEligibility & VerificationConduct 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.AuthorizationsObtain 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 AssuranceEnsure 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.Case Management & CollaborationManage 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 & ReportingMaintain 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.Communication & Patient SupportRespond 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 AttributesExceptional attention to detail and accuracyStrong analytical and problem-solving skillsExcellent communication and customer service abilitiesAbility to handle confidential information with discretionTeam-oriented mindset with a proactive, solutions-driven approachCapable of managing multiple tasks and meeting deadlines in a fast-paced environmentQualificationsHigh school diploma or equivalent; Associate degree in healthcare administration or related field preferredMinimum of 2 years of experience in verification, authorization, eligibility determination, or a related healthcare roleFamiliarity with orthopedic billing codes, payer requirements, and insurance policiesKnowledge of EHR systems and billing software (eClinicalWorks experience preferred)Proficiency in Microsoft Office Suite, especially ExcelStrong communication skills, both written and verbalAbility to work independently and collaboratively within a teamMust be able to work onsite in Somerset County, NJ