Prior Authorization & Care Access Specialist

Independent Living Systems, llc; Miami (FL); On-site; USD 42,000 - 54,000; Full time

Job summary

Independent Living Systems, llc in Miami, FL is seeking a full-time Utilization Management Coordinator. This role reviews prior authorization forms for completeness, determines if services require authorization, and communicates with internal and external customers to facilitate timely access to care.

The position emphasizes adherence to healthcare regulations, medical terminology, and collaboration with Clinical Care Specialists to ensure efficient processing of requests and improved member

Qualifications

• High school diploma or equivalent required.
• 2 years of medical office referral/authorization experience.
• Strong knowledge of healthcare regulations and medical terminology.
• Relevant experience may substitute for the educational requirement on a year-for-year basis.

Responsibilities

• Review prior authorization requests for documentation completeness.
• Determine if the requested service requires authorization.
• Place outbound calls to obtain clinical information as needed.
• Screens and routes requests to the Clinical Care Specialist as appropriate.
• Support timely processing to improve member outcomes.

Skills

Medical office experience

Healthcare regulations knowledge

HIPAA knowledge

CMS guidelines familiarity

Florida Medicaid familiarity

Medical terminology proficiency

Education

High school diploma or equivalent

Associate degree in Health Administration or related field

Job description

Independent Living Systems, llc in Miami, FL is seeking a full-time Utilization Management Coordinator. This role reviews prior authorization forms for completeness, determines if services require authorization, and communicates with internal and external customers to facilitate timely access to care.

The position emphasizes adherence to healthcare regulations, medical terminology, and collaboration with Clinical Care Specialists to ensure efficient processing of requests and improved member