Authorization Specialist II – Behavioral Health

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

📋 Description

• Serve as a resource and provide support for the prior authorization request process to ensure that authorization requests are handled correctly within the specified contractual timelines.

• Assist the utilization management team by documenting authorization requests and securing accurate, timely documentation for healthcare eligibility and access.

• Support the utilization management team and continuously track and document authorizations and referrals in accordance with established policies and guidelines.

• Research and compile medical information including history, diagnosis, and prognosis to aid clinical reviewer determinations.

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

• Align authorizations with guidelines to facilitate timely payment adjudication.

• Conduct data entry to maintain and update authorization requests within the utilization management system.

• Process authorization requests based on the insurance prior authorization list and direct them to the appropriate clinical reviewer.

• Stay updated on healthcare, authorization processes, policies, and procedures.

• Undertake additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• High School diploma or GED.

• 1–2 years of relevant experience.

• Familiarity with medical terminology is preferred.

• Knowledge of insurance is preferred.

• Experience or knowledge in behavioral health is preferred.

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plans.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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