Healthcare Authorization Specialist - Payer & UR (Remote)

Cedars-Sinai; Phoenix (AZ); Remote; USD 65,000 - 90,000; Full time

Job summary

Cedars-Sinai in Phoenix, AZ seeks an experienced Authorization Specialist to manage a caseload in collaboration with UR Nurses and ensure timely utilization review and payer submissions.

You will assemble clinical review packets, track determinations, monitor payer portals, and document outcomes in EPIC/CS-Link, with a focus on avoiding denials and keeping patient information current.

Qualifications

• High school diploma or GED required; associate degree preferred.
• Minimum 2 years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication processes required.
• Experience independently managing authorization workflows highly preferred.
• Minimum of 2 years of acute care experience preferred.

Responsibilities

• Maintain an assigned portfolio of cases in partnership with UR Nurses to support timely utilization review activities.
• Prepare and assemble clinical review packets and supporting documentation for payer submission.
• Review records to confirm required documentation elements are present prior to submission and elevate gaps to the assigned UR Nurse.
• Track submission confirmations and ensure timely follow up on pending payer determinations.
• Manage the authorization lifecycle for assigned cases, including entry, tracking, follow up, documentation of determinations, and monitoring of payer response timelines.
• Monitor payer portals and contact payers directly to obtain authorization updates and resolve status discrepancies.
• Independently prioritize cases based on submission deadlines, authorization expiration risk, and regulatory timeframes.
• Escalate urgent authorization issues to avoid denials or authorization lapses.
• Coordinate peer-to-peer scheduling logistics and maintain related documentation.
• Document and communicate payer determinations in EPIC/CS-Link per standards.
• Identify patterns or systemic authorization workflow issues and communicate trends to UM leadership.

Skills

Authorization management

Utilization review

Payer communication

Revenue cycle

Workflow management

Acute care

Education

HS diploma or GED

Associate degree preferred

Tools

EPIC

CS-Link

Job description

Cedars-Sinai in Phoenix, AZ seeks an experienced Authorization Specialist to manage a caseload in collaboration with UR Nurses and ensure timely utilization review and payer submissions.

You will assemble clinical review packets, track determinations, monitor payer portals, and document outcomes in EPIC/CS-Link, with a focus on avoiding denials and keeping patient information current.