Authorization Specialist II

Immediate need for a talented Authorization Specialist II. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job ID: 25-75054
 
Pay Range: $20 - $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: 

• Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline.
• Supports the utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the member's healthcare eligibility and access.
• Will work on prior authorization requests from doctors, will send out notification letters for denials and approvals.
• Minor phone interactions with providers.
• Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals, following 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, service, and benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
• Performs data entry to maintain and update various authorization requests in the utilization management system
• Supports and processes authorization requests for services by the insurance prior authorization list and routes them 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; Prior Authorization
• Health Insurance / Managed Care
• Medical Terminology
• 2+ years of RECENT EXPERIENCE - Prior Authorizations, Health Insurance and knowledge of Medical Terminology Required.
• Knowledge of Trucare and Amysis is preferred. 
• Basic Computer skills, following directions, Sense of urgency
• Data Entry 40 WPM, Proficient with Microsoft Office (Excel, Word, Outlook, SharePoint, Internet); Multitasking using multiple systems and programs simultaneously. 
• Due to HIPAA, a reliable home internet connection (a hard-wired internet connection) with a dedicated workspace is required.
• Proof of Education: High School/GED or higher is REQUIRED. Must have an on-hand copy of HSD/GED/Transcript.
• Attendance/Reliability is mandatory - no time off allowed during training

 

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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