Authorization Specialist II

Job Title: Authorization Specialist II
Job Location: Remote - but must reside in FL
Job Duration: 3 Months - temp to hire
Shift- Monday - Friday 8 am - 5 pm (1) hour lunch
"Position Purpose:
Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.

Education/Experience:
Requires a High School diploma or GED
Requires 1 - 2 years of related experience

Knowledge of medical terminology and insurance preferred."
"Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines

Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination

Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment

Performs data entry to maintain and update various authorization requests into utilization management system

Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer

Remains up-to-date on healthcare, authorization processes, policies and procedures
Performs other duties as assigned

Complies with all policies and standards"
Story Behind the Need - Business Group & Key Projects will be responsible for reviewing the tasks in the que

• Processing member approvals to match them with a provider
• the performance expectations/metrics for this individual and their team:

95% on audits/ 2% error rate
Typical Day in the Role Education/Certification Required: High School Diploma Preferred: n/a Licensure Required: n/a Preferred: n/a

• Years of experience required
• Best vs. average
• Performance indicators

Must haves:

1. Microsoft Experience (excel experience) - team has seen in previous hires issues with not knowing how to navigate a spreadsheet(s). Must know how to log into platforms, use of TEAMS would be helpful - Microsoft Office Platform
2. Customer Service Experience along the same lines as the field
3. Authorizations and Compliance experience

Nice to haves:

1. Healthcare background
2. Trucare (Centene program)

Disqualifiers:

1. Not knowing how to navigate through Microsoft office

Performance indicators:

• Top 3 must-have hard skills
• Level of experience with each
• Stack-ranked by importance
• Candidate Review & Selection

1 Microsoft Experience (excel experience) - team has seen in previous hires issues with not knowing how to navigate a spreadsheet(s). Must know how to log into platforms, use of TEAMS would be helpful - Microsoft Office Platform
2 Customer Service Experience along the same lines as the field
3 Authorizations and Compliance experience Position is offered by a no fee agency.