BusinessOperations - Authorization Specialist II Authorization Specialist II

BusinessOperations - Authorization Specialist II Authorization Specialist II#25-61078

Columbus, OH

All On-site

Job Description

Job Description: 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.

Education/Experience:

Requires a High School diploma or GED

Requires 1 - 2 years of related experience.

Knowledge of medical terminology and insurance preferred.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

Comments for Vendors:

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Centene Job Description

Story Behind the Need - Business Group & Key Projects

Health plan or business unit

Team culture

Surrounding team & key projects

Purpose of this team

Reason for the request

Motivators for this need

Any additional upcoming hiring needs?

Change in contract turn around time with the Department of Ohio Medicaid (currently 10 day TAT will change to 7-day TAT)

Typical Day in the Role

Daily schedule & OT expectations

Typical task breakdown and rhythm

Interaction level with team

Work environment description

Will interact with the current Authorization Specialist as a team and work in conjunction with the CLINICAL team (Con Current Review Nurses)

Compelling Story & Candidate Value Proposition

What makes this role interesting?

Points about team culture

Competitive market comparison

Unique selling points

Value added or experience gained

Position is very important into the concurrent review team /Utilization Management as well as Buckeye Health Plan/Centene Corporation as an entity...

Candidate Requirements

Education/CertificationRequired: High School diploma/GEDPreferred: NOT preferred

LicensureRequired: N/APreferred: NOT preferred

Years of experience required

Disqualifiers

Best vs. average

Performance indicators

Must haves: High School and/or GED

Nice to haves: Health insurance/Medical terminology

Disqualifiers:

Performance indicators:

Best vs. average:

Top 3 must-have hard skills

Level of experience with each

Stack-ranked by importance

Candidate Review & Selection

1Basic Computer skills

2Following direction

3Sense of urgency

Candidate Review & Selection

Shortlisting process

Second touchpoint for feedback

Interview Information

Onboard Process and Expectations

Projected HM Candidate Review Date:ASAP

Number and Type of Interviews:2 (possibly)

Extra Interview Prep for Candidate:n/a

Required Testing or Assessment (by Vendor):n/a

Manager Communication Preferences & Steps