Authorization Research Specialist IV - J00922

Authorization Research Specialist IV - J00922

BC Forward is looking for Authorization Research Specialist IV


Position Title: Authorization Research Specialist IV
Locations: Remote - USA
Anticipated Start Dates: 11/17
Expected Duration: 4-6 Months
Job Type: Contract with possible extension
Shift: Flexible, 8-hour day shifts , Between 8am and 6pm CST
Pay Rate $28/hr on W2.
Need: 4+ years' experience in healthcare authorizations, claims, denials, and coding with strong knowledge of Medicare/Medicaid, medical terminology, payer compliance, and familiarity with systems like Trucare, Facets, and Care Central.
Interview Process: 1-Phone screen, 2- Virtual with Panel


Job Description:
Position Title: Authorization Specialist - Centralized Transplant Unit (CTU)

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Position Purpose
Reviews and resolves time-sensitive authorization issues that impact claim denials, reconsiderations, or appeals. Provides guidance and expert knowledge in determining root causes and delays in the authorization process to ensure all requirements are completed in accordance with established guidelines.

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Education / Experience

• Required: High School Diploma or GED.
  
• Experience: Minimum 4+ years of related experience.
  
• Preferred: 4+ years of experience in healthcare authorizations, denials, medical claims, coding, and/or collections.
  
• Expert knowledge of Medicare and Medicaid regulations, insurance processes, medical terminology, and payer compliance rules is preferred.
  

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Primary Responsibilities

• Oversee the authorization research process to ensure timely resolution of authorization issues and/or errors.
  
• Analyze and identify complex claim issues related to authorizations that impact claims resolution; collaborate with team members to resolve issues.
  
• Provide subject matter expertise and training to utilization management team members, ensuring efficiency and compliance in the authorization process.
  
• Assist with reporting on authorization volumes and help align staffing assignments.
  
• Manage outreach and resolution of all open or pending authorization issues impacting claim denials, reconsiderations, or appeals.
  
• Review authorization and system errors, ensuring timely resolution in accordance with guidelines.
  
• Report on authorization issues and trends related to claim denials, reconsiderations, and appeals; collaborate across teams to improve authorization processes.
  
• Perform other duties as assigned.
  
• Comply with all company policies and standards.
  

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Story Behind the Need - Business Group & Key Projects
The Centralized Transplant Unit (CTU) will experience staffing shortages from November through February due to maternity leave, sick leave, vacations, and holiday time off. To support the team, three (3) non-clinical professionals will assist with non-clinical workload currently managed by nurses. This support will allow nurses to focus on strictly clinical tasks such as transplant listings and contracting.

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Typical Day in the Role

• Schedule: 8:00 AM - 6:00 PM CST, Monday through Friday (flexible scheduling permitted).
  
• Overtime: Some overtime required; occasional weekend check-ins possible.
  
• Work Environment: Fully remote.
  
• Responsibilities:
  
  • Assess member insurance coverage, services, and benefit eligibility using clinical documentation tools.
    
  • Document authorization requests in UM systems and ensure adherence to TAT and complex authorization requirements.
    
  • Build and complete transplant evaluation requests, validate contracting, and set up P2P.
    
  • Collaborate with Transplant Program Coordinators, Clinical Staff, Leadership, Health Plans, and National Contracting teams.
    

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Compelling Story & Candidate Value Proposition
This is a high-impact, specialized role supporting member access to life-saving transplant care. The position offers exposure to one of healthcare's most complex and meaningful service areas, with collaboration across clinical, policy, contracting, and population health teams. The role provides valuable experience in transplant operations, benefit structures, and policy interpretation.

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Candidate Requirements
Education / Certification:

• Required: High School Diploma or Equivalent.
  
• Experience: Minimum of 4 years in healthcare operations or prior authorization.
  
• Technical Skills: Microsoft Office Suite (Word, Excel, Outlook, Teams, Zoom).
  

Licensure:

• Not applicable.
  

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Preferred Qualifications
Must-Haves:

• Strong understanding of medical terminology.
  
• Proficiency in Microsoft Office Suite.
  
• Ability to manage multiple priorities in a fast-paced setting.
  
• Critical thinking and sound judgment in handling complex authorization scenarios.
  
• Excellent attention to detail and communication skills with clinical and non-clinical audiences.
  
• Understanding of regulatory TATs, policy adherence, and audit requirements.
  
• Proven ability to maintain productivity and accuracy amid evolving processes.
  
• Demonstrates service excellence-empathy, responsiveness, and professionalism.
  
• Commitment to continuous learning in transplant processes, payer policies, and healthcare operations.
  
• Strong data entry skills.
  

Nice-to-Haves:

• Prior experience with authorizations or claims processing.
  
• Excellent organizational skills.
  
• Familiarity with clinical documentation or claims systems (e.g., Trucare Classic, Cloud, Facets, Care Central).
  

Disqualifiers:

• Candidates lacking any of the must-have qualifications.
  

Performance Indicators:

• Turnaround time (TAT).
  
• Production dashboards.
  

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Top 3 Must-Have Hard Skills (Ranked by Importance)

Medical Terminology

4+ years of healthcare operations experience (including UM processes such as PA/intake)

Microsoft Office Suite proficiency

Interested candidates please send resume in Word format Please reference job code 246904 when responding to this ad.

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