Authorization Specialist II

4 weeks ago


Tampa, Florida, United States Randstad Full time

Job Summary

Randstad is seeking a professional healthcare candidate who has experience with authorizations and a strong understanding of medical terminology. The ideal candidate will be proficient with data entry and have excellent attention to detail. This role involves working within multiple systems to review authorization requests from providers, ensuring timely adjudication for payment.

Responsibilities

  • Knowledge of medical terminology and insurance is preferred.
  • Aid the utilization management team in maintaining ongoing tracking and documentation on authorizations and referrals in accordance with policies and guidelines.
  • Support 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.
  • Verify member insurance coverage and/or service/benefit eligibility via system tools and align authorization with guidelines to ensure timely adjudication for payment.
  • Perform data entry to maintain and update various authorization requests into the utilization management system.
  • Support and process authorization requests for services in accordance with the insurance prior authorization list and route to the appropriate clinical reviewer.
  • Remain up-to-date on healthcare, authorization processes, policies, and procedures.

Requirements

  • 2 years of experience in a related field.
  • Experience level: Experienced.

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent, or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer

Randstad is an equal opportunity employer and welcomes people of all abilities. We 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 us.

Benefits

Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).



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