Prior Authorization Specialist I

Specialized Services Coordinator Role: Responsible for screening and coordinating prior-authorization requests for inpatient, outpatient, and ancillary services within the medical care management program. Responsibilities: Processes requests, authorizes services per departmental policies, and forwards complex cases to clinicians or management. Answers provider and department calls, verifies member eligibility, and documents information accurately. Coordinates resolution of escalated inquiries and promotes understanding of authorization processes among members and providers. Maintains knowledge of network resources and member benefits, ensuring compliant and cost-effective healthcare delivery. Qualifications & Skills: Strong communication skills, ability to prioritize, and work efficiently within workflow guidelines. Knowledge of healthcare policies, member handbooks, and extranet systems. No supervisory responsibilities, with supervision provided weekly. #J-18808-Ljbffr Health Marketing