BusinessOperations - Authorization Specialist II - J00904

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

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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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
Story Behind the Need
What is the purpose of this team? What is driving this need? (ex. Backfill for FTE or CW, new project, business growth) Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		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. -The driving need for this is a backfill - The team supports their own team There is a group chat where everyone can ask questions Each team has their own smaller group to connect and discuss with their manager Open communication enjoyable environment Management Team dedicated to team advancement -
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?			They will be responsible for reviewing the tasks in the que; Processing member approvals to match them with a provider The performance expectations/metrics for this individual and their team: 95% on audits/ 2% error rate Family style environment; Remote work
Candidate Requirements
Education/Certification	Required: HS Diploma				Preferred: N/A
Licensure	Required: N/A				Preferred: N/A
Years of experience required: Requires 1 2 years of related experience 1. Microsoft Experience (excel experience) - team has seen in previous hires issues with not knowing how to navigate a spreadsheet(s). Must know how to log into platforms, use of TEAMS would be helpful Microsoft Office Platform 2. Customer Service Experience along the same lines as the field 3. Authorizations and Compliance experience Disqualifiers: Not knowing how to navigate through Microsoft office Additional qualities to look for: Nice to haves: 1. Healthcare background 2. Trucare (Centene program)
Top 3 must-have hard skills stack-ranked by importance			1	Microsoft Experience (excel experience) - team has seen in previous hires issues with not knowing how to navigate a spreadsheet(s). Must know how to log into platforms, use of TEAMS would be helpful Microsoft Office Platform
			2	Customer Service Experience along the same lines as the field
			3	Authorizations and Compliance experience
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations			Projected Manager Candidate Review Date:			1-2 days post shortlisting (for hiring team s reference)
			Type of Interviews:			Teams
			Required Testing or Assessment (by Vendor):			Typing test, basic computers skills test, etc.? N/A