Authorization Specialist II

Authorization Specialist II

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

Position Title: Authorization Specialist II

Location: Remote (EST/CST)

Anticipated Start Date: 12/23/2024

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: 05 months

Job Type: [FULL TIME (>%3D30 HRS WEEKLY, [CONTRACT TO HIRE], [REMOTE]

Pay Range: [$15.00] - [$19.00]

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.).

Requirements:

• Experience in Authorization
• Medical Terminology
• Data Entry

Job Description:

Job Description:

The Authorization Specialist II serves as a key resource within the prior authorization request process, ensuring that all authorization requests are managed in accordance with contractual timelines. This role supports the utilization management team in documenting and tracking authorization requests, ensuring accurate and timely information related to member healthcare eligibility and access. The position requires consistent communication with healthcare providers and clinical reviewers to facilitate the timely and accurate adjudication of authorization requests.

**Key Responsibilities:**

- Support the authorization process by reviewing requests from healthcare providers, ensuring all necessary details are captured.

- Research and document medical information (such as history, diagnosis, and prognosis) to facilitate authorization decisions.

- Verify member insurance coverage and service eligibility using system tools, aligning authorization requests with guidelines to ensure timely adjudication.

- Enter and maintain accurate data for authorization requests within the utilization management system.

- Process authorization requests for services according to the insurance provider's guidelines and route them to appropriate clinical reviewers.

- Ensure compliance with company policies, healthcare regulations, and authorization procedures.

- Stay current on authorization processes, healthcare policies, and industry standards.

- Perform additional duties as assigned by the supervisor.

**Education/Experience:**

- High School diploma or GED required.

- 1-2 years of relevant experience preferred, with familiarity in medical terminology and insurance processes a plus.

**Skills and Knowledge:**

- Strong understanding of medical terminology and insurance processes preferred.

- Ability to manage multiple systems (such as FaxCom, TruCare, Microsoft Platforms) concurrently.

- Excellent attention to detail, accountability, and organization.

- Ability to effectively communicate with healthcare providers and clinical reviewers to obtain necessary documentation.

- Strong computer and technology skills are essential.

- Ability to handle a high-volume workload and maintain accuracy under pressure.

**Performance Expectations:**

- Meet the daily requirement of processing 30-35 authorization requests.

- Flexibility to assist with additional tasks or stretch assignments as needed.

- Strong attendance, adaptability, and a positive attitude are critical.

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.

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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 231741 when responding to this ad.

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