Authorization Specialist II

Centene Corporation • Baton Rouge, LA • 3w ago

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Employees will work five days per week, including either Saturday or Sunday. Shift hours are 10:00 a.m. to 7:00 p.m. CST. Work schedules will be assigned upon completion of training, and employees must be flexible with scheduling.

Position Purpose: Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.

Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines.

Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination.

Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment.

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 and routes to the appropriate clinical reviewer.

Remains up-to-date on healthcare, authorization processes, policies and procedures.

Performs other duties as assigned.

Complies with all policies and standards.

Education/Experience: Requires a High School diploma or GED. Requires 1 - 2 years of related experience. Knowledge of medical terminology and insurance preferred.

Pay Range: $17.50 - $27.50 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Similar Jobs

Wireless Sales Pro

Acosta Group • Walker, LA • 3h ago

Sales & Marketing

Wireless Sales Pro General Information Company: PRE-US Location: WALKER, Louisiana, 70785 Ref #: 86299 Pay Rate: $ 12.50 Experience/skills and/or location may influence position wage rate Function: Brand Advocacy & S...

3h ago

Go to Apply

Kitchen+Bar - Prep Cook

Drury Hotels • Baton Rouge, LA • 3h ago

Retail & Hospitality

Property Location:7939 Essen Park - Baton Rouge, Louisiana 70809-7438You belong at Drury Hotels.Getting a job is just the beginning. Finding a place where you belong is what truly matters. Who you are and what you do mak...

3h ago

Go to Apply

Acute Inpatient Registered Nurse

Fresenius Medical Care North America • Baton Rouge, LA • 6h ago

Hospital & Medical

PURPOSE AND SCOPE: The professional registered nurse Inpatient Services RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). This position is accountable and responsible for the provision a...

6h ago

Go to Apply

Online Survey Taker. Earn up to $25 per survey. - Remote

Earn Haus • Plaquemine, LA • 20h ago

Sponsored

Job description We are urgently looking for people interested in taking online surveys for Fortune 500 brands. If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up to $2...

20h ago

Go to Apply