Authorization Specialist II

Job Description:

• Act as a resource and support the prior authorization request process
• Ensure authorization requests are addressed properly within the contractual timeline
• Support the utilization management team with documentation and tracking of authorization requests and referrals
• Research and document medical information such as history, diagnosis, and prognosis for clinical reviewer determination
• Verify member insurance coverage and service/benefit eligibility using system tools
• Align authorizations with guidelines to ensure timely adjudication for payment
• Perform data entry to maintain and update authorization requests in the utilization management system
• Process authorization requests according to the insurance prior authorization list and route them to the appropriate clinical reviewer
• Stay current on healthcare, authorization processes, policies, and procedures
• Perform other duties as assigned

Requirements:

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
• Must live in the state of Florida
• High School diploma or GED
• 1–2 years of related experience
• Knowledge of medical terminology and insurance preferred
• Compliance with all policies and standards

Benefits:

• Competitive pay
• Health insurance
• 401K plan
• Stock purchase plan
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules
• Additional forms of incentives may be included in total compensation
• Equal opportunity employer committed to diversity