Authorization Specialist III

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

📋 Description

• Collaborate with the utilization management team to assist with the prior authorization request process.

• Ensure that authorization requests are processed correctly within the stipulated contractual timelines.

• Document intricate authorization requests and secure precise, timely documentation regarding member healthcare eligibility and access to services.

• Track and manage authorization requests in accordance with the insurance prior authorization listing.

• Direct requests to the suitable clinical reviewers.

• Confirm member insurance coverage and eligibility for services or benefits.

• Input and update complex authorization requests in the utilization management system.

• Maintain thorough tracking and documentation for authorizations and referrals.

• Investigate providers, policies, preferred in-network providers, and requirements for referral authorizations.

• Provide necessary documentation to health plans.

• Research and document medical information to assist clinical reviewer decisions.

• Sustain relationships with service providers and clinical reviewers.

• Serve as a subject matter expert for team members regarding authorization processes and various service types.

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

• Perform additional duties as assigned.

⛳️ Requirements

• Must reside in the greater Little Rock, AR area.

• Must be authorized 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.

• 2–4 years of relevant experience is necessary.

• Strong understanding of medical terminology and insurance is essential.

• Familiarity with prior authorization processes, insurance coverage, policies, and procedures is required.

• Ability to research health plan providers, policies, referral authorization requirements, medical history, diagnosis, and prognosis.

• Proficiency in utilizing system tools and utilization management systems for data entry and authorization tracking.

• Must adhere to all established policies and standards.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plan.

• Tuition reimbursement.

• Paid time off along with holidays.

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

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