Authorization Specialist II

Authorization Specialist II

BC Forward is looking for Authorization Specialist II (Remote - FL )

Position Title: Authorization Specialist II (Remote - FL )

Locations: Remote - FL

Anticipated Start Date: 03/10

Expected Duration: 12 Months

Job Type: Contract to hire

Shift: The standard schedule consists of Monday to Friday shifts from either 11:00 AM - 8:00 PM EST or 10:00 AM - 7:00 PM EST, along with one weekend day (Saturday or Sunday) following the same time options.

Pay Rate $19.00hr. on W2

Need: Minimum of 2 yrs of Prior Authorizations/Insurance Verification Experience

Job Description:
Work Schedule & Overtime Requirements
Standard Schedule:

• Monday - Friday:
  
  • 11:00 AM - 8:00 PM EST
  • 10:00 AM - 7:00 PM EST
• One Weekend Day (Saturday or Sunday):
  
  • 11:00 AM - 8:00 PM EST
  • 10:00 AM - 7:00 PM EST

Important Notes:

• Once the schedule is confirmed, changes will not be permitted.
• Overtime (OT) requirements will be communicated as needed.

Training Schedule:

• Training sessions will follow either an 8:00 AM - 5:00 PM EST or 9:00 AM - 6:00 PM EST schedule, depending on the learning journey.
• After training is completed, employees will transition to their assigned schedule as determined by leadership.

Prior Authorization Specialist
Position Purpose:
The Prior Authorization Specialist plays a key role in supporting the prior authorization request process to ensure all requests are addressed within contractual timelines. This position collaborates with the utilization management team to document authorization requests and obtain accurate, timely documentation for healthcare services related to member eligibility and access.

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Key Responsibilities:

• Serve as a resource for the prior authorization process, ensuring timely and accurate request processing.
• Assist the utilization management team by tracking and documenting authorizations and referrals in compliance with policies and guidelines.
• Research and document necessary medical information such as history, diagnosis, and prognosis to support clinical review and determination.
• Verify member insurance coverage and benefit eligibility using system tools, ensuring alignment with guidelines for timely claims adjudication.
• Enter and update authorization requests in the utilization management system with accuracy and efficiency.
• Process and route authorization requests based on the insurance prior authorization list, ensuring timely review by clinical teams.
• Stay up to date on healthcare authorization processes, policies, and procedures.
• Participate in weekly team meetings and monthly one-on-one check-ins with supervisors.
• Maintain compliance with all company policies, procedures, and industry standards.
• Perform other duties as assigned.

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Required Qualifications:

• Education: High School Diploma or GED required.
• Experience: 1-2 years of related experience within a medical facility, such as a doctor's office, insurance company, or billing department.
• Skills:
  • Proficiency in Microsoft Office (Excel, Word, Outlook).
  • Strong data entry skills with attention to detail.
  • Knowledge of medical terminology.

Preferred Qualifications:

• Prior experience processing authorizations.
• Familiarity with insurance policies and Medicaid guidelines.
• Experience working in a remote environment.

Typical Day in the Role:

• Process an average of 30 authorization requests per day (2-3 per hour).
• Support Medicaid services, specifically Florida Medicaid.
• Communicate primarily via email and Centene programs (no phone interactions).
• Use FaxBack as the primary communication method for authorizations.
• Attend weekly team meetings for updates and process improvements.
• Participate in monthly one-on-one meetings with supervisors to discuss performance and goals.

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Candidate Profile & Selection Criteria:
Top 3 Must-Have Skills (Ranked by Importance):

Prior Authorization Experience (1-2 years) - Strong knowledge of authorization processes.

Data Entry Proficiency - High attention to detail and accuracy.

Medical Terminology Knowledge - Ability to interpret medical records and terminology.

Disqualifiers:

• Lack of relevant experience in a healthcare, insurance, or billing environment.
• Inability to meet the minimum productivity requirement of 30 authorizations per day.
• Lack of proficiency in Microsoft Office or data entry.

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Why Join Us?

• Fully remote position with a structured schedule.
• Gain valuable experience in healthcare administration and insurance authorization.
• Work with a collaborative team in a fast-paced environment.
• Opportunities for growth and professional development within a leading healthcare organization.

Benefits:
BCforward offers eligible employees a comprehensive benefits package, including major medical, HSA, dental, vision, employer-provided group life insurance, voluntary life insurance, short-term disability, long-term disability, and a 401(k) plan.

About BCforward:
Founded in 1998, BCforward was established to provide industry leaders with expert professional services and workforce management solutions, driving the development and execution of core business and technology strategies. As a Black-owned firm, BCforward delivers innovative solutions that support value capture and digital product delivery for organizations worldwide.

Headquartered in Indianapolis, IN, with an Offshore Development Center in Hyderabad, India, BCforward's team of 6,000 consultants serves over 225 clients globally. Rooted in our core values-People-Centric, Optimism, Excellence, Diversity, and Accountability-we have been helping clients achieve their strategic goals for over 25 years. Our strong culture and commitment to these principles have made BCforward a market leader and an exceptional 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, protected veteran status, or disability.

For more information on how BCforward collects and uses personal information during the recruitment process, please refer to our Privacy Notice and CCPA Addendum. As part of the hiring process, we may request certain personal information, including identifiers, professional and educational details, commercial information, and other relevant data, solely for recruitment purposes.

Interested candidates please send resume in Word format Please reference job code 235853 when responding to this ad.

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