Senior Prior Authorization Specialist - Remote

Centene Corporation; Little Rock (AR); Sur place; USD 28 000 - 47 000; Plein temps

Résumé du poste

Centene Corporation in Little Rock, AR is seeking a Prior Authorization Specialist to support the utilization management team. You will ensure timely processing of authorization requests, verify insurance coverage, and document complex cases for clinical reviewers.

The role requires 2–4 years of related experience, strong medical terminology knowledge, and the ability to work without visa sponsorship. This position focuses on accuracy, timeliness, and collaboration with providers and reviewers.

Qualifications

• High school diploma or GED required.
• 2–4 years of related experience.
• Authorized to work in the U.S. without sponsorship.
• Experience with prior authorization and utilization management systems.

Responsabilités

• Track and maintain authorization requests per the PA list and route to clinical reviewer.
• Verify member insurance coverage and eligibility to align authorizations for timely adjudication.
• Perform data entry to update complex authorizations in the UM system.
• Maintain documentation on authorizations and referrals per policies.
• Develop knowledge of prior authorization processes to support clinical reviewers.
• Research health plan providers to identify in-network providers and referral requirements.
• Provide guidance on the authorization review process by documenting medical information.
• Maintain relationships with providers and reviewers to ensure timely referrals.
• Serve as a subject matter expert for the authorization process across service types.
• Stay up-to-date on healthcare policies and procedures.
• Comply with all policies and standards.

Connaissances

Medical terminology

Insurance knowledge

Prior authorization

Data entry

Attention to detail

Formation

High School diploma or GED

Description du poste

Centene Corporation in Little Rock, AR is seeking a Prior Authorization Specialist to support the utilization management team. You will ensure timely processing of authorization requests, verify insurance coverage, and document complex cases for clinical reviewers.

The role requires 2–4 years of related experience, strong medical terminology knowledge, and the ability to work without visa sponsorship. This position focuses on accuracy, timeliness, and collaboration with providers and reviewers.