Authorization Specialist II

Fidelis Care - New York; New York (NY); Hybrid; USD 37,000 - 58,000; Full time

Benefits offered by this job

Remote work options

Hybrid work model

Job summary

Centene, operating through Fidelis Care - New York, seeks a role in prior authorization support within the utilization management team. You will document and process authorizations, verify coverage, and ensure timely adjudication in line with guidelines.

This role requires a high school diploma or GED and 1–2 years of related experience, with familiarity in medical terminology and insurance preferred. We offer remote, hybrid, field or office work arrangements and a comprehensive benefits

Qualifications

• Requires a High School diploma or GED.
• Knowledge of medical terminology and insurance preferred.
• 1–2 years of related experience may be required.

Responsibilities

• Aids the utilization management team and maintains tracking on authorizations and referrals.
• Researches and documents medical information for clinical reviewers.
• Verifies member insurance coverage and aligns authorizations with guidelines for timely adjudication.
• Performs data entry to update authorization requests in the utilization management system.
• Supports and processes authorization requests per the insurance prior authorization list.
• Keeps up-to-date on healthcare policies, procedures, and authorization processes.
• Performs other duties as assigned and complies with all policies.

Skills

Medical terminology

Insurance knowledge

Education

High School diploma or GED

Job description

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.

Key Details:

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

• 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

Education/Experience:

Requires a High School diploma or GED. Requires 1 – 2 years of related experience. Knowledge of medical terminology and insurance preferred.

Pay Range: $17.84 - $28.02 per hour

About Centene:

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act