Authorization Specialist II

🔥 0 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $17 - $28 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 documentation and tracking of authorization requests and referrals • Research and document medical information, including history, diagnosis, and prognosis, for clinical reviewer determination • Verify member insurance coverage and service/benefit eligibility using system tools • Align authorizations with guidelines to support timely payment adjudication • Perform data entry and update authorization requests in the utilization management system • Process authorization requests according to the insurance prior authorization list • Route requests to the appropriate clinical reviewer • Remain 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 • High School diploma or GED required • 1–2 years of related experience required • Knowledge of medical terminology and insurance preferred • Maintain accurate and timely documentation • Comply with all policies and standards

🏖️ Benefits

• Competitive pay • Health insurance • 401K • 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