Authorization Specialist II

Authorization Specialist II

BC Forward is looking for Authorization Specialist II (REMOTE)

Position Title: Authorization Specialist II (REMOTE)

Locations: Remote - CST or EST

Anticipated Start Date: 02/03

Expected Duration: 6 Months

Job Type: Contract with possible extension and temp to hire

Pay Rate: $19/hour on W2

Shift: Tuesday through Saturday, 8:00 AM to 5:00 PM CST (with weekly overtime opportunities).

Need: Min 2yrs of Healthcare/Authorizations AND Strong Data Entry with min 50WPM.

Job Description:
Position Purpose:
Serve as a vital resource in the prior authorization process to ensure timely and accurate handling of authorization requests in compliance with contractual timelines. Support the Utilization Management team by documenting, tracking, and verifying authorization requests while facilitating seamless access to healthcare services for members.

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Day-to-Day Responsibilities:

• Utilize multiple systems, including FaxCom, TruCare, and Microsoft platforms, to review and process authorization requests from healthcare providers.
• Identify incomplete authorization requests and send faxes back to providers to gather additional details as needed.
• Assist with stretch assignments or support other areas based on work volumes, demonstrating flexibility and a team-oriented mindset.
• Adapt to changes in business processes and workflows, maintaining productivity in a dynamic environment.

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Performance Expectations/Key Metrics:

• Authorization Requests: Process 30-35 authorization requests daily as a baseline requirement.
• Scalability: Handle higher volumes of requests depending on system efficiency, turnaround time, and specific authorization requirements.

Required Skills/Experience:

1-2 years of related experience.

Detail-oriented with a strong focus on accuracy.

Demonstrates accountability and a proactive approach to tasks.

Proficient in working with multiple systems simultaneously.

Strong understanding of computers and technology.

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Preferred Skills/Experience:

Previous work-from-home experience.

Ability to adapt to changing processes and environments.

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Education Requirement:

• High School diploma or GED required.

Education & Experience:

• High School Diploma or GED required.
• 1-2 years of relevant experience preferred.
• Familiarity with medical terminology and insurance processes is advantageous.

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Key Responsibilities:

• Authorization Management:
  
  • Assist the Utilization Management team by tracking and documenting prior authorization requests and referrals in alignment with policies and guidelines.
  • Research and compile essential medical information, such as patient history, diagnoses, and prognoses, to aid clinical reviewers in decision-making.
• Eligibility Verification:
  
  • Verify member insurance coverage and/or benefit eligibility using system tools.
  • Align authorization requests with established guidelines to ensure timely adjudication for payment processing.
• Data Entry & System Updates:
  
  • Maintain and update records of authorization requests in the utilization management system with a high degree of accuracy.
• Process Support:
  
  • Facilitate the processing of authorization requests in accordance with the prior authorization list, ensuring proper routing to clinical reviewers as necessary.
• Policy Adherence:
  
  • Stay current on healthcare trends, authorization procedures, and company policies.
  • Perform all duties in compliance with organizational policies, standards, and guidelines.
• Other Duties:
  
  • Contribute to other assigned tasks as required to support the Utilization Management team's objectives.

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This version simplifies the content for clarity, enhances the readability, and places emphasis on the importance of the role in ensuring smooth healthcare service delivery.

Benefits
BCforward offers a comprehensive benefits package for eligible employees, which includes:

• Major medical coverage
• Health Savings Account (HSA)
• Dental and vision plans
• Employer-provided group life insurance
• Voluntary life insurance options
• Short-term and long-term disability coverage
• 401(k) retirement plan

About BCforward
Founded in 1998, BCforward is a Black-owned professional services and workforce management firm committed to driving business and technology success. Headquartered in Indianapolis, IN, with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants deliver innovative solutions to more than 225 clients worldwide.

BCforward leverages human potential to help organizations transform, accelerate growth, and scale operations. Our core values-People-Centric, Optimism, Excellence, Diversity, and Accountability-guide us in supporting our clients' strategic goals. With over 25 years of experience, we have established ourselves as a market leader and an employer of choice.

Commitment to Diversity and Inclusion
BCforward is an equal opportunity employer. We welcome and value diversity in our workplace. All qualified applicants will be considered for employment regardless of race, color, religion, gender, sexual orientation, gender identity, national origin, veteran status, or disability.

Privacy and Recruitment Process
To learn more about how BCforward collects and uses personal information during the recruitment process, please review our Privacy Notice and CCPA Addendum. As part of this process, you may be asked to provide personal details, including identifiers, professional and educational information, and other related data. BCforward ensures this information is used solely to complete the recruitment process.

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Interested candidates please send resume in Word format Please reference job code 234512 when responding to this ad.

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