Authorization Specialist III

Job not on LinkedIn

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $20 - $34 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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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

• Work with the utilization management team to support the prior authorization request process • Ensure authorization requests are addressed properly within contractual timelines • Document complex authorization requests and obtain accurate, timely documentation for member healthcare eligibility and service access • Track and maintain authorization requests according to the insurance prior authorization list • Route requests to appropriate clinical reviewers • Verify member insurance coverage and service or benefit eligibility • Enter and update complex authorization requests in the utilization management system • Maintain tracking and documentation for authorizations and referrals • Research providers, policies, preferred in-network providers and referral authorization requirements • Provide supporting documentation to health plans • Research and document medical information for clinical reviewer determinations • Maintain relationships with service providers and clinical reviewers • Act as a subject matter expert for team members across authorization processes and service types • Remain current on healthcare authorization processes, policies and procedures • Perform other duties as assigned

🎯 Requirements

• Must be located in the greater Little Rock, AR area • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future • High School diploma or GED • Requires 2–4 years of related experience • Strong knowledge of medical terminology and insurance • Knowledge of prior authorization processes, insurance coverage, policies and procedures • Ability to research health plan providers, policies, referral authorization requirements, medical history, diagnosis and prognosis • Ability to use system tools and utilization management systems for data entry and authorization tracking • Must comply with all policies and standards

🏖️ Benefits

• Health insurance • 401K plan • Stock purchase plan • 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