Authorization Specialist

• Act as a resource and support the prior authorization request process
• Ensure authorization requests are addressed properly within contractual timelines
• Support the utilization management team in documenting authorization requests
• Obtain accurate and timely documentation for services related to members’ healthcare eligibility and access
• Maintain ongoing tracking and appropriate documentation on authorizations and referrals
• Research and document medical information such as history, diagnosis, and prognosis for clinical review
• Verify member insurance coverage and service/benefit eligibility using system tools
• Align authorizations with guidelines to ensure timely payment adjudication
• Perform data entry to maintain and update authorization requests in the utilization management system
• Process authorization requests according to the insurance prior authorization list
• Route requests to the appropriate clinical reviewer
• Remain 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.