Authorization Specialist
1 week ago
BCforward is seeking a highly motivated Authorization Specialist to join our team in a remote opportunity.
Job Summary:The Authorization Specialist will act as a resource and support the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline.
Key Responsibilities:- Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
- 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.
- Authorizations experience or experience with healthcare management systems.
- Provider or Insurance experience & Knowledge of medical terminology and insurance.
- Familiar with Compliance.
- Strong written, verbal, and interpersonal skills, Customer Service, Time Management.
- Microsoft Office/excel.
BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.
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