Authorization Specialist I
About The Position
Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline. Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access. Supports authorization requests for services in accordance with the insurance prior authorization list Supports and performs data entry to maintain and update authorization requests into utilization management system Assists utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines Contributes to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination Remains up-to-date on healthcare, authorization processes, policies and procedures Performs other duties as assigned Complies with all policies and standards
Requirements
- Requires a High School diploma or GED.
- Entry-level position typically requiring little or no previous experience.
- Understanding of medical terminology and insurance preferred.
Responsibilities
- Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline.
- Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
- Supports authorization requests for services in accordance with the insurance prior authorization list
- Supports and performs data entry to maintain and update authorization requests into utilization management system
- Assists utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
- Contributes to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
- Remains up-to-date on healthcare, authorization processes, policies and procedures
- Performs other duties as assigned
- Complies with all policies and standards
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
