Authorization Specialist II

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

📋 Description

• Serve as a key resource and assist with the prior authorization request process.

• Ensure that authorization requests are handled appropriately within contractual timeframes.

• Provide support to the utilization management team in documenting authorization requests.

• Acquire accurate and prompt documentation for services related to members’ healthcare eligibility and access.

• Maintain ongoing tracking and proper documentation of authorizations and referrals.

• Research and document medical information, including history, diagnosis, and prognosis, for clinical review.

• Verify member insurance coverage and service/benefit eligibility using system tools.

• Align authorizations with guidelines to guarantee timely payment adjudication.

• Conduct data entry to keep authorization requests updated in the utilization management system.

• Process authorization requests according to the insurance prior authorization list.

• Direct requests to the appropriate clinical reviewer.

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

• Perform additional duties as assigned.

⛳️ Requirements

• Applicants must reside in the state of Missouri.

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

• A High School diploma or GED is required.

• 1–2 years of related experience is necessary.

• Familiarity with medical terminology and insurance is preferred.

• Compliance with all policies and standards is mandatory.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements with options for remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.