- Lawrenceville, New Jersey, United States
- On-site
- Full-time · Mid
- $36–$47 per hour
- 3+ years
Responsible for proactive authorization controls that protect claim readiness and revenue prior to billing. Performs both pre-service authorization verification and post-procedure pre-bill validation.
Compensation
Pay Range: $35.69 - $46.63
Responsibilities
- Performs proactive authorization controls that protect claim readiness and revenue prior to billing.
- Performs both pre-service authorization verification and post-procedure pre-bill validation to ensure the authorization aligns with services actually performed.
- Works high-risk scheduled and procedural accounts (for example OR, Cath Lab, IR, advanced imaging, and other prior-auth-dependent services).
- Coordinates timely corrections with Central Scheduling, clinical departments, physician offices, and revenue cycle teams.
- Identifies and resolves variances such as missing authorization, incorrect CPT, wrong units, wrong site/setting, expired authorization, and add-on procedure gaps.
Requirements
- High school diploma or equivalent
- Nice to have: Registered Nurse (RN) license
- Nice to have: Certification or license in surgical or diagnostic procedures
- Nice to have: procedural/surgical authorizations
- Nice to have: account-level pre-bill review