Remote/Hybrid Prior Authorization Specialist II

Fidelis Care - New York; New York (NY); Hybrid; USD 37,000 - 58,000; Full time

Benefits offered by this job

Remote work options

Hybrid work model

Job summary

Centene, operating through Fidelis Care - New York, seeks a role in prior authorization support within the utilization management team. You will document and process authorizations, verify coverage, and ensure timely adjudication in line with guidelines.

This role requires a high school diploma or GED and 1–2 years of related experience, with familiarity in medical terminology and insurance preferred. We offer remote, hybrid, field or office work arrangements and a comprehensive benefits

Qualifications

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

Responsibilities

• Aids the utilization management team and maintains tracking on authorizations and referrals.
• Researches and documents medical information for clinical reviewers.
• Verifies member insurance coverage and aligns authorizations with guidelines for timely adjudication.
• Performs data entry to update authorization requests in the utilization management system.
• Supports and processes authorization requests per the insurance prior authorization list.
• Keeps up-to-date on healthcare policies, procedures, and authorization processes.
• Performs other duties as assigned and complies with all policies.

Skills

Medical terminology

Insurance knowledge

Education

High School diploma or GED

Job description

Centene, operating through Fidelis Care - New York, seeks a role in prior authorization support within the utilization management team. You will document and process authorizations, verify coverage, and ensure timely adjudication in line with guidelines.

This role requires a high school diploma or GED and 1–2 years of related experience, with familiarity in medical terminology and insurance preferred. We offer remote, hybrid, field or office work arrangements and a comprehensive benefits