Authorization Specialist II

Authorization Specialist II

BC Forward is looking for Authorization Specialist I (Remote EST/CST)

Position Title: Authorization Specialist I (Remote EST/CST)

Locations: (Remote EST/CST)
Anticipated Start Date: 07/21
Expected Duration: 6 Months
Job Type: Contract
Shift: 8am to 5pm
Pay Rate $23.00/hr. on W2
Need:2-3 years of experience as a Authorization Specialist

Job Description:


Position Purpose:
Serve as a vital support resource in the prior authorization process, ensuring that all requests are handled accurately, efficiently, and within contractual timelines. Work collaboratively with the Utilization Management (UM) team to document and manage authorization requests, promoting timely and appropriate healthcare access for members.

Collaborates closely with the current Authorization Specialist and works in coordination with the Clinical team, including Concurrent Review Nurses, to ensure seamless communication and workflow.

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Education & Experience Requirements:

• High school diploma or GED required
  
• 1-2 years of related healthcare or administrative experience required
  
• Knowledge of medical terminology and health insurance processes preferred
  

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Key Responsibilities:

• Support the Utilization Management team by tracking, entering, and documenting authorizations and referrals in alignment with internal policies and external regulations.
  
• Assist in the authorization review process by researching and compiling relevant medical information (e.g., patient history, diagnosis, prognosis) for clinical review.
  
• Verify insurance coverage and service/benefit eligibility using internal systems and align authorization requests with applicable guidelines to ensure timely claim processing.
  
• Accurately enter and update authorization data into the utilization management system.
  
• Process and route prior authorization requests according to payer-specific requirements, escalating to clinical reviewers as needed.
  
• Maintain up-to-date knowledge of healthcare authorization protocols, payer policies, and organizational procedures.
  
• Partner effectively with both administrative and clinical teams to promote coordinated care.
  
• Perform additional duties as assigned.
  
• Ensure full compliance with all organizational standards, procedures, and confidentiality requirements.
  

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Must-Have Qualifications:

• High school diploma or GED
  
• Basic computer proficiency
  
• Ability to follow directions accurately
  
• Strong sense of urgency and attention to detail
  

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Nice-to-Have Qualifications:

• Familiarity with medical terminology
  
• Experience in health insurance or healthcare administrative processes
  

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.

Interested candidates please send resume in Word format Please reference job code 239462 when responding to this ad.

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