Performance Ortho ยท 2 days ago
Eligibility Specialist
Bridgewater, NJ
Full-time
Hybrid
Entry, Mid Level
2+ years expPerformance Ortho is a top-tier orthopedic and outpatient care provider dedicated to excellence in clinical outcomes and compassionate care. The Eligibility & Insurance Authorization Specialist plays a critical role in ensuring patients can access care by verifying insurance eligibility, obtaining pre-authorizations, and maintaining accurate documentation for billing and clinical operations.
Health CareMedicalRehabilitationTherapeuticsWellness
Hiring Manager
Kayla Leon
Responsibilities
Verify patient insurance eligibility, benefits, coverage limitations, and plan details prior to appointments or procedures
Identify and communicate changes in insurance status, plan requirements, or benefit restrictions to patients and staff
Confirm patient demographics and insurance information are accurate in the EHR system
Review and document deductible, co-pay, and co-insurance amounts for patient financial counseling
Obtain and track prior authorizations and pre-certifications for medical procedures, imaging, therapy, and other clinical services
Follow up on pending authorizations to prevent delays in patient care
Communicate with insurance companies to resolve denials or incomplete requests
Maintain an organized tracking system for all authorizations, including expiration dates and renewal needs
Collaborate with front desk, scheduling, billing, and clinical teams to ensure accurate and complete information for authorization requests
Notify providers and patients of authorization status, benefit coverage, or eligibility issues in a timely and professional manner
Provide clear, compassionate support to patients with insurance or authorization questions
Record all verification and authorization activities accurately in the electronic health record (EHR)
Ensure compliance with HIPAA, payer-specific guidelines, and internal company policies
Identify and escalate trends in denials or payer discrepancies to management
Partner with billing and clinical operations to streamline authorization workflows
Participate in process improvement initiatives aimed at reducing denials and improving turnaround times
Support staff training and serve as a resource for insurance and eligibility-related inquiries
Qualification
Required
High School Diploma or equivalent
Minimum 2 years of experience in insurance eligibility verification and/or prior authorization
Working knowledge of medical terminology and insurance coding (CPT, ICD-10)
Familiarity with commercial insurance plans, Medicare/Medicaid, and managed care procedures
Proficiency in EMR/EHR systems and Microsoft Office applications
Must be able to work onsite in Somerset County, NJ
Preferred
Experience in orthopedic, outpatient, or surgical services settings
Bilingual proficiency a plus
Benefits
401(k) with employer matching
Health, Dental, and Vision Insurance
Generous Paid Time Off + Holidays
Paid Leave of Absence Support
Professional Development Assistance
Culture-focused Leadership Team
Company
Performance Ortho
Most people with spine and joint pain don't know where to turn. We understand how frustrating it can be to find the care you need.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Matthew Brigante
Chief Operating Officer
Jessica Mendoza
Executive Assistant To Chief Operations Officer
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