Authorization Specialist III

Job Summary

A company is looking for an Authorization Specialist III to support the prior authorization request process within the utilization management team.

Key Responsibilities

• Track and maintain authorization requests for services in accordance with insurance guidelines
• Verify member insurance coverage and assess service eligibility to ensure timely payment adjudication
• Act as a subject matter expert for the authorization process and maintain relationships with service providers and clinical reviewers

Required Qualifications

• High School diploma or GED required
• 2 - 4 years of related experience preferred
• Strong knowledge of medical terminology and insurance
• Ability to research health plan providers and policies
• Familiarity with authorization processes, policies, and procedures