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 US(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-75053

Pay Range: $22.50 - $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:

• Working Hours: M-F 8-5 temp time.
• 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
• 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
• Complies with all policies and standards
• 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.
•  Will work on prior auth request from Drs.
• Will send out notification letters for denials and approvals.
• Minor phone interactions with providers.

Key Requirements and Technology Experience: 

• Key Skills; Authorization, Insurance & Microsoft Office
• Requires a High School diploma or GED
• Requires 1 – 2 years of related experience.
• High School diploma
•  Insurance or Auth experience
•  Experience with computers/office setting.
•  Trucare
• Amysis

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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