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 with documentation and tracking of authorization requests and referrals
• Research and document medical information for referral to clinical reviewers
• Verify member insurance coverage and service/benefit eligibility
• Align authorizations with guidelines to support timely payment adjudication
• Enter 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 up-to-date on healthcare, authorization processes, policies, and procedures
• Comply with all policies and standards
• Perform other duties as assigned

Authorization Specialist jobs in New York

Authorization Specialist II