Authorization Specialist II

1 day ago

Tallahassee FL USA, United States Centene Corporation Full time
Job Title: Authorization Specialist II

Join Centene Corporation, a leading healthcare company, as an Authorization Specialist II. In this role, you will play a critical part in ensuring that our 28 million members receive timely and accurate authorization for their healthcare services.

Job Summary:

The Authorization Specialist II will serve as a resource and support the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. This includes supporting the utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members' healthcare eligibility and access.

Key Responsibilities:
  • 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
  • Remains up-to-date on healthcare, authorization processes, policies and procedures
Requirements:
  • Requires a High School diploma or GED
  • Requires 1 – 2 years of related experience
  • Knowledge of medical terminology and insurance preferred
What We Offer:

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.

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