BusinessOperations - Authorization Specialist II

Immediate need for a talented

Authorization Specialist II . This is a

12+ months contract

opportunity with long-term potential and is located in

AZ ( Remote ). Please review the job description below and contact me ASAP if you are interested.

Job ID : 25-87848

Pay Range : $22 - $23 / hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities :

Shift :

8 AM - 5 PM MST (Mon-Fri) -

Weekends and Holidays work may be required.

The AS team process authorization requests for Inpatient, Outpatient and OOH services, all lines of business (Medicaid, Medicare, Marketplace).

The purpose of hiring is to ensure CMS compliance rule, 7-day TAT.

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 align 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 prior insurance authorization list and routes to the appropriate clinical reviewer.

Remains up to date on healthcare, authorization processes, policies, and procedures.

Performs other duties as assigned.

Complies with all policies and standards.

Key Requirements and Technology Experience :

Key Skills; 1 - 2 years of related experience.

Authorization experience is highly preferred.

Knowledge of medical terminology and insurance preferred.

Ability to use grammar appropriately.

Ability to be computer proficient and stay on task.

Team player - someone willing to learn, has strong communication skills, etc.

Our client is a leading

Healthcare Industry

and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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