[Hiring] Authorization Specialist II @Centene Corporation

Role Description

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.

Qualifications

• Requires a High School diploma or GED.
• Requires 1 – 2 years of related experience.
• Knowledge of medical terminology and insurance preferred.

Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
• This is a fully remote opportunity, and candidates may reside and work from anywhere within the United States.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.

Company Description

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.