Verification / Authorization Specialist

Job Title : Verification / Authorization Specialist

Location : Performance Ortho Corporate Office (Bridgewater, NJ)

Employment Type : Full-time, Hybrid 2 days remote

Schedule : Monday – Friday

About Us

Performance 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 24 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 Overview

The 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 Responsibilities

Eligibility & Verification

• Conduct 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.

Authorizations

Compliance & Quality Assurance

Case Management & Collaboration

Documentation & Reporting

Communication & Patient Support

Preferred Candidate Attributes

Qualifications