- 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
- Preferred experience in processing authorization and working in health care field
- Knowledge of medical terminology preferred.
- Knowledge of insurance preferred.
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Authorization Specialist II - Dallas, United States - TEKsystems
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
Roles and Responsibilities-
Additional Skills & Qualifications:
• Healthcare Customer Service Representative (2 years of experience)
• Referral Specialist (2 years of experience)
Preferred Skills/ Experience:
Experience Level:
Intermediate Level
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Authorization Specialist II professionals in Dallas
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Martin Ndzelen
Accomplished and result-oriented IT Security Specialist with 11 years of experience in networking (r ...