Prior Authorization Specialist II — Utilization Management

Centene Corporation; Missouri; Ibrido; USD 25.000 - 39.000; Tempo pieno

Descrizione del lavoro

Centene Corporation in Missouri is seeking a candidate to support the prior authorization process within the utilization management team. You will help ensure timely documentation and review to determine eligibility and service authorizations. Requirements include a High School diploma or GED and 1–2 years of related experience.

Knowledge of medical terminology and insurance is preferred. Pay range is $17.84–$28.02 per hour, with US work authorization required now or in the future, plus

Competenze

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

Mansioni

• 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

Conoscenze

Medical terminology

Insurance knowledge

Formazione

High School diploma or GED

Descrizione del lavoro

Centene Corporation in Missouri is seeking a candidate to support the prior authorization process within the utilization management team. You will help ensure timely documentation and review to determine eligibility and service authorizations. Requirements include a High School diploma or GED and 1–2 years of related experience.

Knowledge of medical terminology and insurance is preferred. Pay range is $17.84–$28.02 per hour, with US work authorization required now or in the future, plus