Authorization Specialist

• Act as a resource and support the prior authorization request process
• Ensure authorization requests are addressed properly within the contractual timeline
• Support the utilization management team with documentation and tracking of authorization requests and referrals
• Research and document medical information such as history, diagnosis, and prognosis for clinical reviewer determination
• Verify member insurance coverage and service/benefit eligibility using system tools
• Align authorizations with guidelines to ensure timely adjudication for payment
• Perform data entry to maintain and update authorization requests in the utilization management system
• Process authorization requests according to the insurance prior authorization list and route them to the appropriate clinical reviewer
• Stay current on healthcare, authorization processes, policies, and procedures
• Perform other duties as assigned

Explore Authorization Specialist II at Centene Corporation. Review requirements and application details.