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Authorization Specialist III
2 months ago
Centene Corporation is seeking a highly skilled Authorization Specialist III - Clinical Professional to join our Medical Management/Health Services team. As a key member of our team, you will play a critical role in ensuring that all authorization requests are addressed properly in a timely manner.
Key Responsibilities- Work with the utilization management team to support the prior authorization request process, ensuring that all requests are addressed in accordance with contractual timelines.
- Document complex authorization requests and obtain accurate and timely documentation for services related to member healthcare eligibility and access.
- Track and maintain authorization requests for services in accordance with the insurance prior authorization list and route to the appropriate clinical reviewer.
- Verify and assess 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 complex authorization requests into the utilization management system.
- Maintain ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines.
- Develop in-depth knowledge of prior authorization review processes and insurance coverage to support prior authorization processes for clinical reviewers and providers.
- Research health plan providers and policies to identify preferred in-network providers and requirements for referral authorization, providing supporting documentation to health plans.
- Provide guidance and support to the authorization review process by researching and documenting necessary medical information, such as history, diagnosis, and prognosis, based on referrals to clinical reviewers for determination.
- Maintain 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.
- Remain up-to-date on healthcare, authorization processes, policies, and procedures.
- Strong knowledge of medical terminology and insurance.
- Perform other duties as assigned.
- Requires a High School diploma or GED.
- Requires 2 - 4 years of related experience.
- Competitive pay: $19.62 - $33.36 per hour.
- A comprehensive benefits package, including health insurance, 401K, and stock purchase plans.
- Tuition reimbursement.
- Paid time off plus holidays.
- A flexible approach to work with remote, hybrid, field, or office work schedules.
