Authorization Specialist II at Centene

Ideal for an administrative professional with at least one to two years of experience in a clinical or insurance environment. You must hold a High School diplom

Work type: remote

Location: Remote-AZ | Remote-CA

Salary: $18 – $28/hr

Type: Full-time

Summary

Ideal for an administrative professional with at least one to two years of experience in a clinical or insurance environment. You must hold a High School diploma or GED and be authorized to work in the United States without future visa sponsorship. **What makes it worth a look...** Centene offers a fully remote role based in AZ or CA with pay ranging from $17.84 to $28.02 per hour. The position provides comprehensive benefits including health insurance, 401K plans, and tuition reimbursement. **You might be a good fit if you...** * Possess direct experience navigating medical terminology and insurance eligibility verification. * Are comfortable performing data entry within complex utilization management systems. * Can document patient history, diagnosis, and prognosis to support clinical reviewers. * Understand the prior authorization process and related regulatory guidelines.

Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPTPosition Purpose: Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.

• 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


• Complies with all policies and standards

Knowledge of medical terminology and insurance preferred.

Pay Range: $17.84 - $28.02 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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