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Surgical Authorization Specialist

Surgical Authorization Specialist

Progressive Spine and Orthopaedics LLC CareersClifton, New Jersey, US
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JOB TITLE : Surgical Authorization Specialist

SUMMARY : The Surgical Authorization Specialist at Progressive Spine & Orthopaedics is responsible for securing and managing surgical authorizations, with a focus on complex cases involving Motor Vehicle Accidents (MVA), Workers’ Compensation (WC), and Personal Injury Protection (PIP).

This role requires strong knowledge of out-of-network processes, legal documentation requirements, and payer-specific regulations. The Surgical Authorization Specialist works independently to navigate multi- party communications between insurance carriers, attorneys, adjusters, and healthcare providers to ensure timely approvals and accurate records, helping to prevent surgical delays.

DUTIES AND RESPONSIBILITIES :

  • Obtain surgical authorizations for cases involving out-of-network carriers, WC, MVA and PIP, ensuring compliance with state regulations and carrier requirements.
  • Review and compile necessary clinical and legal documentation, including letters of medical necessity, operative notes, accident reports, and attorney requests.
  • Communicate regularly with attorneys, adjusters, and case managers to secure required approvals and resolve documentation gaps.
  • Track and follow up on pending authorizations to avoid delays in surgery scheduling.
  • Navigate unique or complex payer situations, such as multiple insurance carriers or disputed

claims.

  • Submit appeals for denied authorizations, preparing thorough documentation and

    • coordinating with physician for peer-to-peer reviews when needed.

  • Maintain detailed, accurate records in the EMR for every authorization case, including all correspondence, phone calls, and submitted materials.
  • Stay informed on state-specific WC and PIP authorization rules and changes in insurance carrier processes.
  • Coordinate with Surgical Coordinators to ensure authorization status is clearly

    • communicated and any delays are addressed proactively.

  • Prioritize workload to meet strict surgery timelines while handling a high volume of cases.
  • Performs other related duties as assigned by management.

    • QUALIFICATIONS :

  • High school diploma or equivalent; additional education or certification in healthcare administration or related field preferred.
  • Minimum of 2 years’ experience in medical or surgical authorization, with direct experience in WC, MVA, and PIP cases preferred.
  • Strong understanding of out-of-network authorization processes, state WC regulations, and PIP laws.
  • Experience communicating with attorneys, adjusters, and case managers.
  • Knowledge of medical terminology and surgical procedures, preferably orthopaedic.
  • Proficiency with EMR systems, insurance portals, and Microsoft Office applications.
  • Excellent attention to detail, organizational skills, and ability to manage multiple priorities in a fast-paced environment.
  • Strong verbal and written communication skills.

    • GENERAL EXPECTATIONS :

  • Maintain confidentiality of patient and practice information in compliance with HIPAA.
  • Work collaboratively with physicians, staff, and external parties to achieve timely

    • authorizations.

  • Demonstrate professionalism, reliability, and respect in all communications.
  • Complete work accurately and within established timelines, even under high caseload

    • pressure.

    COMPENSATION :

    Pay based on experience and qualifications

    In accordance with the New Jersey Pay Transparency Act, this position falls within Pay Grade 7 of the 2025 OPM Salary Table for the NY, NJ, CT, and PA region.

    PI62e3ae78d3b5-37344-38808328

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    Authorization Specialist • Clifton, New Jersey, US