Remote Authorization Specialist II – Prior Authorization

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

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.