Authorization Specialist II

Authorization Specialist II

Requirements

• High School diploma or GED
• 1 – 2 years of related experience
• Knowledge of medical terminology and insurance preferred

Responsibilities

• Acts as a resource and supports the prior authorization request process
• Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals
• Supports the authorization review process by researching and documenting necessary medical information
• Verifies member insurance coverage and/or service/benefit eligibility via system tools
• Performs data entry to maintain and update various authorization requests into utilization management system
• Supports and processes authorization requests for services in accordance with the insurance prior authorization list
• Remains up-to-date on healthcare, authorization processes, policies and procedures
• Performs other duties as assigned
• Complies with all policies and standards

Preferred Qualifications

• Knowledge of medical terminology and insurance preferred