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Authorization Specialist III
2 months ago
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
****Qualified candidates must reside in Texas***
**Position Purpose:** Works with the utilization management team and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline Documents some complex authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
+ Tracks and maintains authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer
+ Verifies and assesses 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 some complex authorization requests into utilization management system
+ Maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
+ Develops in-depth knowledge of prior authorization review process and insurance coverage to support prior authorization process for clinical reviewers and providers
+ Researches health plan providers and polices to identify preferred in-network providers and requirements for referral authorization; provides supporting documentation to health plan
+ Provides some guidance and support of 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
+ Maintains relationships with service providers and clinical reviewers to ensure referrals are addressed in a timely manner
+ Act as a subject matter expert to other team members for the overall authorization process and for multiple service types at different levels of urgency
+ Remains up-to-date on healthcare, authorization processes, policies and procedures
+ Strong knowledge of medical terminology and insurance
+ Performs other duties as assigned
+ Complies with all policies and standards
**Education/Experience:** Requires a High School diploma or GED.
Requires 2 - 4 years of related experience.
Pay Range: $19.62 - $33.36 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
