Authorization Specialist II

Immediate need for a talented Authorization Specialist II. This is a 03+months Contract to Hire opportunity with long-term potential and is located in U.S(Remote – Florida). Please review the job description below and contact me ASAP if you are interested.
 
Job ID:25-63913
 
Pay Range: $17 - $19/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 Schedule: Training is from 8-5 or 9-6 based on learning journey. Once training is completed the new hire will follow the schedule below.
• Monday through Friday
• 11 am – 8 pm EST
• 10 am – 7 pm EST
• 1 Weekend Day (Saturday or Sunday)
• 11 am – 8 pm EST
• 10 am – 7 pm EST
• 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 utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
• Knowledge of medical terminology and insurance preferred.
• Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines.
• Building authorizations from provider requests (2-3 Auths per hours ~ 30 per day).
• 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 aligns 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 insurance prior 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.

Key Requirements and Technology Experience:

• Key Skills:Authorization , Prior Authorization , Insurance Verification.
• Requires a High School diploma or GED.
• Requires 1 – 2 years of related experience.
• 1-2 years of related experience within a medical facility (doctor’s office, insurance, billing, etc.).
• Microsoft Office Experience .
• Data Entry .
• Knowledge of Medical Terminology.
• Authorization Experience.
• Insurance knowledge.
• Remote Work Experience.

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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