Authorization Specialist II - J00904

Authorization Specialist II - J00904

Bcforward is seeking for Authorization Specialist II - Remote.

Job Title: Authorization Specialist II
Location: Remote (Excluding NY and CA)
Pay Rate: $23/hour
Assignment Duration: 6 Months (Possibility to extend or convert)
Work Schedule: Monday to Friday, 8:00 AM - 5:00 PM

Position Purpose

The Authorization Specialist II is responsible for supporting the prior authorization request process to ensure all requests are completed within required timelines. This role works closely with the Utilization Management team to track, document, and support authorization workflows that align with health plan policies and member eligibility.

Key Responsibilities

• Process and track authorization and referral requests per policy.
• Verify insurance coverage and member eligibility using system tools.
• Research and document clinical information (e.g., diagnosis, prognosis, history) to support the review process.
• Route service requests appropriately based on prior authorization requirements.
• Enter and update data in the utilization management system.
• Generate and send notifications (approval or denial letters).
• Stay current with healthcare policies, prior authorization procedures, and system updates.
• Perform additional duties as assigned in compliance with Centene policies.

Qualifications

Education:

• Required: High School Diploma or GED

Experience:

• Required: 1-2 years of relevant experience in insurance or prior authorization
• Preferred: Familiarity with medical terminology and insurance guidelines

Skills:

• Strong attention to detail and data entry accuracy
• Effective communication with providers (minor phone interaction)
• Basic to intermediate computer proficiency in an office setting
• Ability to meet performance metrics (e.g., daily notification volumes)

Preferred Systems Experience

TruCare

Amysis

Work Environment & Culture

• Remote role with limited phone communication
• Collaborative team with monthly meetings
• Fast-paced yet supportive environment with clear deliverables
• Opportunity to gain valuable healthcare administration experience in a national organization.

Interested candidates please send resume in Word format Please reference job code 239810 when responding to this ad.

---