Authorization Specialist II

BCForward is looking for Authorization Specialist II at Florida

Position: Authorization Specialist II
Location: Remote (Florida Residents Only)

Duration: 12 Months

Potential to Extend: YES

Start Date: As soon as possible
Pay Rate: $19.00/hr. on W2

Shift: Monday - Friday, 8:30 AM - 5:30 PM EST

Position Purpose:

The Authorization Specialist II acts as a key resource in supporting the prior authorization request process to ensure all requests are addressed in a timely manner according to contractual timelines. The specialist will assist the utilization management team by documenting authorization requests, verifying eligibility, and ensuring proper authorization processes are followed. This role involves managing the authorization process for healthcare services, ensuring accurate and timely documentation for services related to member eligibility and access.

Key Responsibilities:

• Support the authorization review process by researching and documenting necessary medical information (history, diagnosis, prognosis) for clinical reviewers.
• Verify member insurance coverage and service/benefit eligibility using system tools to ensure timely and accurate adjudication of payments.
• Assist in managing authorization requests, ensuring alignment with insurance guidelines, and routing them to the appropriate clinical reviewer.
• Perform data entry to maintain and update authorization records in the utilization management system.
• Aid in tracking and documenting authorization requests, referrals, and the status of services according to policies and procedures.
• Remain up-to-date on healthcare authorization processes, policies, and procedures.
• Provide email communication and support via Centene programs, ensuring timely and accurate responses to providers (no phone communication required).
• Process at least 30 authorizations per day, ensuring compliance with performance metrics.
• Participate in Centene University Training to ensure proper system access and equipment setup.
• Perform other duties as assigned and comply with all organizational policies and standards.

Education & Experience Requirements:

• Required: High School Diploma or GED
• Required Experience: 1-2 years of related experience in a healthcare or authorization-related role (e.g., medical office, insurance, billing)
• Preferred Experience: Knowledge of medical terminology and insurance, authorization experience, customer service, and data entry.
• Preferred Education: N/A

Skills & Competencies:

• Strong communication skills (written and verbal), especially through email and Centene programs.
• Proficient in Microsoft Office Suite and other computer systems for data entry and tracking.
• Strong attention to detail, with the ability to follow procedures and guidelines.
• Ability to work efficiently in a remote work environment.
• Technically savvy with strong data entry experience and comfort using healthcare management systems.
• Team player with the ability to learn quickly and contribute to a positive, collaborative work environment.
• Experience with Medicaid services is a plus.

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 231452 when responding to this ad.