BusinessOperations - Authorization Specialist II

Immediate need for a talented Authorization Specialist II. This is a 12+ months contract opportunity with long-term potential and is located in AZ(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-87848

Pay Range: $22 - $23/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shift: 8 AM - 5 PM MST (Mon-Fri) - Weekends and Holidays work may be required.
• The AS team process authorization requests for Inpatient, Outpatient and OOH services, all lines of business (Medicaid, Medicare, Marketplace).
• The purpose of hiring is to ensure CMS compliance rule, 7-day TAT.
• Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines.
• Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination.
• Verifies member insurance coverage and/or service/benefit eligibility via system tools and align authorization with the guidelines to ensure a timely adjudication for payment.
• Performs data entry to maintain and update various authorization requests into utilization management system.
• Supports and processes authorization requests for services in accordance with the prior insurance authorization list and routes to the appropriate clinical reviewer.
• Remains up to date on healthcare, authorization processes, policies, and procedures.
• Performs other duties as assigned.
• Complies with all policies and standards.

Key Requirements and Technology Experience: 

• Key Skills; 1 – 2 years of related experience.
• Authorization experience is highly preferred.
• Knowledge of medical terminology and insurance preferred.
• Ability to use grammar appropriately.
• Ability to be computer proficient and stay on task.
• Team player – someone willing to learn, has strong communication skills, etc.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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