Precertification Associate

This role is onsite - 5 days a week 9-5 - Office located in Fair Lawn, NJ

Garden State Orthopaedic is looking for a Precertification Associate. This role is responsible for verifying patient insurance eligibility, submitting and tracking prior authorization requests with payers, and maintaining accurate authorization records in internal systems. The Associate communicates status updates to clinical and scheduling teams, follows up with payers within required timeframes, and escalates delays or denials to the supervisor as needed. Success in this role requires strong attention to detail, organized follow-through, and clear communication with both internal staff and external insurance companies, all in accordance with HIPAA and practice standards.

Core Responsibilities

• Submit and track prior authorization/precertification requests in accordance with payer requirements
• Verify patient insurance eligibility and benefits for planned services
• Communicate with insurance companies via phone and online portals
• Enter and maintain accurate authorization data (reference numbers, CPT/diagnosis codes, status, expiration dates)
• Follow up on pending requests within required timeframes to support scheduling readiness
• Coordinate with clinical and scheduling teams on authorization status and issues
• Escalate delays, missing information, or potential denials to the supervisor promptly
• Assist with denial documentation and administrative support for the appeals process
• Maintain complete records in compliance with HIPAA and practice standards

Qualifications

• High School Diploma or GED required
• 1+ year of customer service experience
• Experience in medical office, insurance verification, billing, or authorization preferred (training provided)
• Strong organizational, communication, and data entry skills
• Basic computer proficiency; ability to learn payer portals and internal systems

Pay: $21.00 - $22.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off

Application Question(s):

• Are you able to work in our Fairlawn office - 5 days a week from 9-5?

Experience:

• customer service in medical field: 1 year (Required)

Work Location: In person