Prior Authorization Specialist III – Remote-Friendly

Centene Corporation; United States; Hybrid; USD 42,000 - 72,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible schedules: remote, hybrid, or

Job summary

Centene is seeking a skilled Authorization Specialist to support the prior authorization request process and ensure timely documentation for services related to member healthcare eligibility and access. The role is based in the greater Little Rock, AR area and requires 2-4 years of related experience.

You will verify coverage and align authorizations with guidelines, perform data entry, and maintain ongoing documentation while collaborating with clinical reviewers and providers.

Qualifications

• Requires 2-4 years of related experience.
• Must be located in greater Little Rock, AR area.
• Authorized to work in the U.S. without sponsorship now or in the future.

Responsibilities

• Tracks and maintains authorization requests for services per the prior authorization list.
• Verifies member insurance coverage and eligibility to ensure timely adjudication for payment.
• Performs data entry to maintain complex authorization requests in the utilization management system.
• Maintains documentation on authorizations and referrals per policies.
• Grows knowledge of prior authorization review process to support clinical reviewers and providers.
• Researches health plan policies to identify in-network providers and referral requirements.
• Provides guidance and documents medical information to support the authorization review process.
• Maintains relationships with providers and reviewers to ensure timely referrals.
• Acts as a subject matter expert for authorization processes across service types.
• Keeps up-to-date on healthcare, authorization processes, policies, and procedures.

Skills

Medical terminology

Insurance knowledge

Prior authorization process

Data entry

Clinical collaboration

Education

High School diploma or GED

Job description

Centene is seeking a skilled Authorization Specialist to support the prior authorization request process and ensure timely documentation for services related to member healthcare eligibility and access. The role is based in the greater Little Rock, AR area and requires 2-4 years of related experience.

You will verify coverage and align authorizations with guidelines, perform data entry, and maintain ongoing documentation while collaborating with clinical reviewers and providers.