Prior Authorizations Specialist

Our client is seeking a detail-oriented Authorization & Out-of-Network Specialist to join their Utilization Management team. In this role, you will act as a key resource in supporting the prior authorization request process, ensuring all cases are processed accurately and within contractual timelines. You will work closely with out-of-network authorization workflows, assist with member redirection to in-network providers, and support single case agreement (SCA) processes by gathering and routing necessary clinical and contractual details.

salary: $22 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

• Authorization Tracking: Document and track authorization requests and referrals according to established policies and guidelines.
• Out-of-Network & SCA Support: Review out-of-network requests to guide members to in-network providers and submit single case agreement data to contracting teams.
• Clinical Documentation: Gather medical details (history, diagnosis, prognosis) to prepare cases for clinical reviewer determination.
• Eligibility & Benefit Verification: Confirm member coverage and service eligibility to ensure proper alignment for timely payment.
• Data Entry & System Maintenance: Input, update, and manage authorization requests within the utilization management system.
• Provider Outreach: Make occasional calls to healthcare providers to clarify case details while spending most of the day navigating internal systems.
• Compliance: Follow all prior authorization guidelines, maintain policy standards, and stay current on team workflows.

Skills

• Utilization Management (2 years of experience is required)
• Benefit Verification (2 years of experience is required)
• Prior Authorization (2 years of experience is required)
• EMR
• Basic Software Skills
• Written Communication

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

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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.