Authorization Specialist II

🔥 2 minutes ago

🌵 Arizona, Florida, +1 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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 tracking and documentation of authorizations and referrals • Research and document medical information for clinical reviewer determinations • Verify member insurance coverage and service/benefit eligibility • 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 • Stay current on healthcare authorization processes, policies, and procedures • Comply with all policies and standards • 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 • Requires a High School diploma or GED • Requires 1–2 years of related experience • Knowledge of medical terminology and insurance preferred • Must accurately document authorization requests and obtain timely documentation • Knowledge of healthcare authorization processes, policies, and procedures • Ability to use system tools and utilization management systems • Ability to perform data entry • Ability to research and document medical information including history, diagnosis, and prognosis • Ability to verify member insurance coverage and service/benefit eligibility

🏖️ 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 • Equal opportunity employer committed to diversity