Authorization Specialist II – Behavioral Health

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🔥 0 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $17 - $28 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Act as a resource and support the prior authorization request process to ensure authorization requests are addressed properly within contractual timelines • Support the utilization management team by documenting authorization requests and obtaining accurate, timely documentation for healthcare eligibility and access • Aid the utilization management team and maintain ongoing tracking and documentation on authorizations and referrals according to policies and guidelines • Research and document medical information such as history, diagnosis, and prognosis for clinical reviewer determinations • Verify member insurance coverage and service/benefit eligibility using system tools • Align authorizations with guidelines to support timely payment adjudication • 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 • Comply with all policies and standards

🎯 Requirements

• High School diploma or GED • 1–2 years of related experience • Knowledge of medical terminology preferred • Knowledge of insurance preferred • Behavioral health experience/knowledge preferred • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future

🏖️ Benefits

• Competitive pay • Health insurance • 401K plans • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules