BCforward
Authorization Specialist - RemoteBCforward is currently seeking a highly motivated
Authorization Specialist II - REMOTE
for an opportunity in
North Carolina, NC.Job Details:Job Title:
Authorization Specialist IILocation:
North Carolina, NCDuration:
9+ months of contractPay Rate:
$21/hr. on W2Anticipated Start:
ASAPJob 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.Knowledge of medical terminology and insurance preferred.Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelinesSupports 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 determinationVerifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for paymentPerforms data entry to maintain and update various authorization requests into utilization management systemSupports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewerRemains up-to-date on healthcare, authorization processes, policies and proceduresPerforms other duties as assignedComplies with all policies and standardsEducation/Experience:Requires a High School diploma or GEDRequires 1 - 2 years of related experience.Interested candidates please send resume in Word format Please reference job code 235785 when responding to this ad.
Authorization Specialist II - REMOTE
for an opportunity in
North Carolina, NC.Job Details:Job Title:
Authorization Specialist IILocation:
North Carolina, NCDuration:
9+ months of contractPay Rate:
$21/hr. on W2Anticipated Start:
ASAPJob 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.Knowledge of medical terminology and insurance preferred.Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelinesSupports 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 determinationVerifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for paymentPerforms data entry to maintain and update various authorization requests into utilization management systemSupports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewerRemains up-to-date on healthcare, authorization processes, policies and proceduresPerforms other duties as assignedComplies with all policies and standardsEducation/Experience:Requires a High School diploma or GEDRequires 1 - 2 years of related experience.Interested candidates please send resume in Word format Please reference job code 235785 when responding to this ad.