Authorization Specialist IV

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. •

Fully remote role. Candidate may reside in any state in the US.

* Position Purpose: Leads the prior authorization request process to ensure work queue is managed and addressed properly. Provides guidance and expert knowledge to utilization management team on documenting the most complex authorization requests to ensure accurate and timely documentation for services related to the members healthcare eligibility and access. • Assesses and analyzes member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment • Reviews authorization requests to ensure authorization requests are documented in the utilization management system and are in accordance with policies and procedures • Develops in-depth knowledge of prior authorization review process and insurance coverage including responding to complex or escalated authorization requests • Maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines • Act as a subject matter expert as well as a trainer to other team members for the overall authorization process and for multiple service types at different levels of urgency • Oversees the authorization review process of utilization management team members researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination • Assists with aging reports and audits • Reviews escalations and works on resolving them in a timely manner • Assists with reporting on authorization volumes and alignment on staffing assignments. Ensures referrals are addressed in a timely manner by service providers and clinical reviewers. • Leads, oversees, and maintains authorization requests for services in accordance with the insurance prior authorization list • Remains up-to-date on healthcare, authorization processes, policies and procedures • Expert knowledge of medical terminology and insurance • Performs other duties as assigned • Complies with all policies and standards Education/Experience: Requires a High School diploma or GED Requires 4+ years of related experience.Pay Range: $22.50 - $38.02 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. Total compensation may also include additional forms of incentives. 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 Apply Job!