Job Overview

Our client is seeking an experienced Workers’ Compensation (W/C) and Personal Injury Protection (PIP) Authorization Specialist to manage the authorization and approval process for medical treatments, procedures, and therapy services related to W/C and PIP claims. The ideal candidate will have hands-on experience working with insurance carriers, submitting authorization requests, following up on pending approvals, and managing denials or appeals.

Schedule: Monday - Friday, 9:00 AM - 6:00 PM EST, with 1 hour unpaid break (40 work hours per week)

Responsibilities

• Obtain prior authorizations and approvals for medical treatments, procedures, and therapy services related to PIP and Workers’ Compensation claims.
• Verify patient insurance coverage, eligibility, and benefits, with a focus on PIP/W/C coverage.
• Prepare and submit authorization requests with complete and accurate supporting documentation.
• Maintain current knowledge of PIP and Workers’ Compensation regulations, guidelines, and insurer-specific requirements.
• Collaborate with physicians, therapists, clinical staff, and administrative teams to ensure accurate and timely submissions.
• Proactively follow up with insurance carriers regarding pending authorizations, approvals, denials, and appeals.
• Track authorization status, deadlines, and required follow-ups to prevent delays in patient care.
• Document all authorization requests, communications, approvals, denials, and outcomes in the EMR system.
• Ensure all medical records and supporting documentation are complete, current, and within the required date ranges for submission.
• Educate patients regarding their PIP/W/C benefits, coverage limitations, and potential out-of-pocket responsibilities when applicable.
• Manage denied authorization requests by initiating appeals and submitting the appropriate supporting documentation.
• Coordinate with billing and collections teams to support accurate claims processing and reimbursement.
• Maintain strict HIPAA compliance and protect patient confidentiality in all communications and documentation.

Requirements

• Prior experience working specifically with Workers’ Compensation and/or PIP authorization processes is required.
• Hands-on experience submitting authorization requests to insurance carriers for medical services, procedures, or physical therapy is highly preferred.
• Experience following up with insurance companies regarding pending authorizations and obtaining approval status.
• Experience handling authorization denials and submitting appeals or additional documentation.
• Familiarity with PIP/W/C insurance requirements, medical documentation, and authorization guidelines.
• Experience working with EMR systems and documenting insurance communications.
• Strong attention to detail and excellent organizational and follow-up skills.
• Strong written and verbal communication skills.
• Ability to work independently while collaborating effectively with clinical, administrative, billing, and insurance teams.
• Knowledge of HIPAA regulations and patient confidentiality requirements.
• Healthcare administration, medical billing, insurance verification, or prior authorization experience is a plus.

Independent Contractor Perks

• Health Insurance Coverage for eligible locations
• Permanent work from home
• Immediate hiring

Note

Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.