Authorization Specialist II

Centene Corp.; Northern (KY); Hybrid; USD 25,000 - 39,000; Full time

Job summary

Centene Corp. seeks an Authorization Specialist II to support the prior authorization process and assist the utilization management team in documenting and tracking authorizations efficiently. The role emphasizes timely adjudication and compliance with policy guidelines.

The candidate will verify insurance coverage, research medical history, and enter data into the utilization management system. This is a remote, Missouri-based opportunity with competitive hourly pay.

Qualifications

• Knowledge of medical terminology and insurance preferred.
• Experience with authorization or utilization management is a plus.

Responsibilities

• 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

Skills

Medical terminology

Insurance knowledge

Education

High School diploma or GED

Job description

## Authorization Specialist IIApply: Remote-MO: Full time: Posted Today: 1668078**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:** Qualified candidates must be located in the state of Missouri. 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