About the position
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Candidates must be available to work 10am to 7pm or 11am to 8pm PST. Hours could change based on business needs. Position Purpose: 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. 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.
Responsibilities
- Acts as a resource and supports the prior authorization request process.
- Supports utilization management team to document authorization requests.
- Obtains accurate and timely documentation for services related to members' healthcare eligibility and access.
- Maintains ongoing tracking and appropriate documentation on authorizations and referrals.
- Supports the authorization review process by researching and documenting necessary medical information.
- Verifies member insurance coverage and/or service/benefit eligibility.
- Performs data entry to maintain and update various authorization requests.
- Supports and processes authorization requests for services.
- Remains up-to-date on healthcare, authorization processes, policies and procedures.
- Performs other duties as assigned.
Requirements
- Requires a High School diploma or GED.
- Requires 1 - 2 years of related experience.
- Knowledge of medical terminology and insurance preferred.
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
