Authorization Specialist

Job Summary

Supporting the prior authorization request process, the full-time remote Authorization Specialist will manage complex authorization requests, verify member insurance coverage, and maintain documentation to ensure timely adjudication for payment.

Key responsibilities

• Tracks and maintains authorization requests in accordance with insurance prior authorization lists and routes them to clinical reviewers
• Verifies member insurance coverage and service eligibility, aligning authorizations with guidelines for timely payment adjudication
• Acts as a subject matter expert on the authorization process, providing guidance and support to team members and maintaining relationships with service providers

Required qualifications

• High School diploma or GED required
• 2 - 4 years of related experience in healthcare or insurance authorization
• Strong knowledge of medical terminology and insurance processes
• Ability to research health plan providers and policies for referral authorization
• Experience with data entry and maintaining complex authorization requests in a utilization management system