BCforward
Specialist I, Prior Authorization - Remote
BCforward - Matthews
Work at BCforward
Overview
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Overview
Authorization Specialist - Remote BCforward is currently seeking a highly motivated Authorization Specialist II - REMOTE for an opportunity in North Carolina, NC.
Job Details:
Job Title: Authorization Specialist II
Location: North Carolina, NC
Duration: 9+ months of contract
Pay Rate: $21/hr. on W2
Anticipated Start: ASAP
Job 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 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
Education/Experience:
Requires a High School diploma or GED
Requires 1 - 2 years of related experience.
Interested candidates please send resume in Word format Please reference job code 235785 when responding to this ad.
Job Details:
Job Title: Authorization Specialist II
Location: North Carolina, NC
Duration: 9+ months of contract
Pay Rate: $21/hr. on W2
Anticipated Start: ASAP
Job 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 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
Education/Experience:
Requires a High School diploma or GED
Requires 1 - 2 years of related experience.
Interested candidates please send resume in Word format Please reference job code 235785 when responding to this ad.