Authorization Specialist II

BCforward is currently seeking a highly motivated Authorization Specialist II for a Remote opportunity!

Position Title: [Authorization Specialist II]

Location: [Remote ]

Anticipated Start Date: [3/3/2025]

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Expected Duration: [3 Months]

Job Type: [FULL TIME (<30 HRS WEEKLY)], [CONTRACT/REMOTE]

Pay Range: [$17-18/Hr. on W2]

Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Position Purpose:
Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.

Education/Experience:
Requires a High School diploma or GED
Requires 1 - 2 years of related experience.

Knowledge of medical terminology and insurance preferred.
Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
Performs data entry to maintain and update various authorization requests into utilization management system
Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer
Remains up-to-date on healthcare, authorization processes, policies and procedures
Performs other duties as assigned
Complies with all policies and standards

Interested candidates please send resume in Word format Please reference job code 234710 when responding to this ad.

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