Authorization Specialist II

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Serve as a resource and assist in the prior authorization request process to ensure that requests are handled correctly within contractual timelines.

• Aid the utilization management team with the documentation and monitoring of authorization requests and referrals.

• Investigate and document medical information, encompassing history, diagnosis, and prognosis, for the determination of clinical reviewers.

• Confirm member insurance coverage and service/benefit eligibility by utilizing system tools.

• Align authorizations with guidelines to facilitate prompt payment adjudication.

• Execute data entry tasks to maintain and update authorization requests in the utilization management system.

• Process authorization requests in accordance with the insurance prior authorization list and direct them to the suitable clinical reviewers.

• Stay informed about healthcare authorization processes, policies, and procedures.

• Undertake other duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Must be eligible to work in the U.S. without requiring employment-based visa sponsorship now or in the future.

• High School diploma or GED is required.

• 1–2 years of relevant experience is preferred.

• Familiarity with medical terminology and insurance is advantageous.

• Capability to work Tuesday–Saturday or Sunday–Thursday is necessary.

• Ability to work from 10:00 a.m. to 7:00 p.m. Central Time.

• Understanding of healthcare authorization processes, policies, and procedures is essential.

• Commitment to compliance with all policies and standards.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentives may be included in total compensation.

• Equal opportunity employer dedicated to diversity.