Authorization Specialist II

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🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – 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 • Ensure authorization requests are addressed properly within contractual timelines • Support the utilization management team with documenting authorization requests • Obtain accurate and timely documentation for services related to members' healthcare eligibility and access • Track and document authorizations and referrals according to policies and guidelines • 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 for timely payment adjudication • Enter and update authorization requests in the utilization management system • Process service authorization requests according to the insurance prior authorization list • Route requests to the appropriate clinical reviewer • Stay up to date on healthcare, authorization processes, policies and procedures • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future • Qualified candidates must reside in the state of Missouri • High School diploma or GED required • Requires 1–2 years of related experience • Knowledge of medical terminology preferred • Knowledge of insurance preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • 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