Job Details

Immediate need for a talented BusinessOperations - Authorization Specialist II. This is a 06 months contract opportunity with long-term potential and is located in California(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-90597

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:

• 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.
• Remains up-to-date on healthcare, authorization processes, policies and procedures.
• Performs other duties as assigned.

Key Requirements and Technology Experience:

• Key Skills;Authorization
• Claims
• Health Insurance
• Claims experience /review claims - Authorization experience / creating Authorization - Validating dates - meeting compliance - Experience with HMO / PPO / Medicaid insurance plans, appeals experience .
• HS Diploma/GED .

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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