Authorization Specialist I

In this role, you will support the prior authorization process to ensure all requests are addressed accurately and within contractual timelines. You will work closely with the utilization management team to manage high volumes of incoming requests, obtain necessary medical information, and ensure timely access to healthcare services based on member eligibility. Responsibilities Process and manage authorization requests for services in accordance with insurance prior authorization lists and guidelines. Work efficiently from a queue of incoming authorizations received via systems such as Outlook or FileNet. Perform accurate data entry to maintain, update, and document authorization requests within the utilization management system. Conduct proactive outreach to providers and members, and generate necessary correspondence and letters. Assist the utilization management team with the ongoing tracking and documentation of authorizations and referrals. Contribute to the clinical review process by accurately documenting essential medical information (such as patient history, diagnosis, and prognosis) for clinical reviewers. Stay current on healthcare regulations, authorization processes, and internal policies. Perform other related duties as assigned. Required Qualifications and Experience Experience: 1 to 2 years of experience in a Prior Authorization Specialist role or similar prior authorization capacity. Industry Knowledge: Solid understanding of medical terminology and health insurance protocols. Top 3 Must Have Skills Tech-Savvy Multitasking: Ability to seamlessly navigate multiple software systems at once while actively speaking with providers or members. Communication: Exceptional written and verbal communication skills, backed by highly professional phone etiquette. Documentation: Strict attention to detail with strong, accurate clinical documentation skills.  

salary: $22.98 - $23 per hour
shift: First
work hours: 8:30 AM - 4 PM
education: High School

Responsibilities

Hired Candidates will be working from a queue of received authorizations. The cases may be received via Outlook or FileNet.  
The candidate will document in Facets.  They will be required to make outreach to providers and members, generate letters. 
The performance metrics is approximately 1.5 cases/hour. 
Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline. Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
Supports authorization requests for services in accordance with the insurance prior authorization list
Supports and performs data entry to maintain and update authorization requests into utilization management system
Assists utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
Contributes to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
Remains up-to-date on healthcare, authorization processes, policies and procedures
Performs other duties as assigned

Skills

• multitask
• communication skills
• Documentation skills

Qualifications

• Years of experience: 1 year
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.