Rev Cycle Specialist; Prior Authorizations

Rev Cycle Specialist (Prior Authorizations)

Job Category
: STAFF - CLINICAL OPERATIONS

Requisition Number
: REVCY
006612

• Posted :
  November 24, 2025
• Full-Time
• On-site

Showing 1 location

NJE Clinical CBO
420 Mountain Ave
4th Floor
New Providence, NJ 07974, USA

• Identifies all appointments and procedures that require prior-authorization by monitoring system reports
• Reviews patient diagnoses and medical notes/laboratory reports required for prior-authorizations submissions
• Accountable for knowledge of updated drug and procedure prior-authorization requirements, relating to all commercial insurance carriers
• Communicates with Insurance carriers by phone for cases of urgency, down systems, research/clarifications or troubleshooting
• Independently maintains and updates multiple reports on all upcoming patient appointments and prior-authorizations
• Utilizes insurance portals to submit prior-authorizations
• Troubleshoots prior-authorization cases for insurances
• Manages a high-volume demand for prior-authorizations with accuracy
• Attends and participates in NJ Retina / or payer meetings/seminars as needed
• Maintains open, positive cordial, team-oriented lines of communications with managers and staff members
• Contributes to the Business office team thought, positive attitude, respectful interaction, innovative ideas and efficiently
• Other duties as assigned

Essential

Qualifications:

Education: High School Diploma or equivalent;
Bachelor’s degree preferred.

Experience: 1+ years’ experience in an administrative role; medical billing experience within Ophthalmology preferred but not required.

Knowledge/Skills/

Experience:

• Working knowledge of prior-authorization process
• Experience with Medicare, insurances, claims, appeals
• Knowledge of CPT, ICD-9 and/or ICD-10 codes a plus
• Able to work in a high volume/fast-paced environment
• Excellent written and verbal communication skills
• Outstanding attention to detail and excellent time management skills
• Outstanding typing and computer skills with billing software, Microsoft Word and Microsoft Excel
• Ability to work with sensitive and confidential information

Hourly Pay Range-
$21.8500 to $25.00 USD

At PRISM Vision Group, we believe great work deserves great rewards. Here’s what you can expect when you join our team:

• Competitive Compensation
  – Base salary, performance bonuses, and regular reviews.
• Health & Wellness
  – Comprehensive medical, dental, and vision insurance; and wellness program.
• Retirement Planning
  – 401(k) with company match.
• Generous Time Off
  – Paid vacation, sick leave, and company holidays.
• Other Perks
  – Commuter benefits, Voluntary Accident and Critical Illness plans, FSA/HSA and Dependent Care FSA. employee discounts, and more.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.