Senior Prior Authorization Specialist III

Centene Corporation; Arkansas; Hybrid; USD 58,428,000 - 99,187,000; Full time

Job summary

Centene Corporation is seeking a Prior Authorization Specialist to support the utilization management team. You will review and process authorization requests, verify coverage, and ensure timely adjudication within contract terms.

This role requires coordinating with clinical reviewers and providers to gather medical information and documentation. The position demands 2–4 years of related experience, strong medical terminology, and familiarity with insurance processes.

Qualifications

• Requires 2–4 years of related experience in health care or insurance.
• Located in the greater Little Rock, AR area.
• Authorized to work in the U.S. without visa sponsorship now or in the future.
• Strong knowledge of medical terminology and insurance.

Responsibilities

• Tracks and maintains authorization requests for services according to the prior authorization list.
• Verifies member insurance coverage and aligns authorization with guidelines for timely adjudication.
• Performs data entry to update complex authorization requests in the utilization management system.
• Maintains documentation on authorizations and referrals per policies.
• Supports clinical reviewers and providers through the prior authorization process.
• Researches health plan policies to identify in-network providers and referral requirements.
• Provides documentation to health plans to support reviews.
• Maintains relationships with providers and reviewers to ensure timely referrals.
• Acts as a subject matter expert on the authorization process across service types.

Skills

Medical terminology

Insurance knowledge

Documentation

Education

High School diploma or GED

Tools

Utilization management system

Job description

Centene Corporation is seeking a Prior Authorization Specialist to support the utilization management team. You will review and process authorization requests, verify coverage, and ensure timely adjudication within contract terms.

This role requires coordinating with clinical reviewers and providers to gather medical information and documentation. The position demands 2–4 years of related experience, strong medical terminology, and familiarity with insurance processes.