Prior Authorization Specialist
🔒 Direct submission to hiring team • Zero candidate fees
Role & Company Overview
📋 Role Overview & Responsibilities
OVERVIEW:Our client, a provider of Health, Dental, Vision, Medicaid, and Medicare Healthcare service plans in the state of California with 4.7 million members and $22.9 billion of annual revenues, seeks an accomplished Prior Authorization Specialist.
IMPORTANT NOTES:This would be work from home role. Work Schedule: (M-F) 8:00 AM – 05:00 PM (Pacific Time)Candidate MUST have high-speed wired internet connection. Wi-Fi / Wireless connections are not allowed. Candidate MUST have a reliable home-office environment.
RESPONSIBILITIES:In this role you will be required to process phone and faxed requests for Continuity of Care, Access to Care for both commercial and Medi-Cal membership. This role may also require Peer or Peer provider support and other duties within Medical Care Solutions. Process faxed/phoned in authorizations, UM/CM requests, special processing/case types and/or calls left on voicemail. Monitor specific queues/workstreams and generates pre-defined reports to identify and resolve common errors. Handle customer/provider problematic calls. Check member history for case management triage and research member eligibility/benefits and provider networks. Assign initial EOA days, or triage to nurses, based on established workflow. Assist with audit file prep. Collaborate with team members on difficult cases for best practices. Promote and maintain and ensure a safe, secure, and healthy work environment by following standards and procedures and complying with company policy. Assist our Clinical staff with case questions, research, and special requests.
QUALIFICATIONS / REQUIREMENTS:Minimum High School Diploma. Candidate must have prior authorizations background handling medical claims within Health insurance industry experience. Care coordination. MSO outreach. Healthcare admin support. Must be familiar with Medical terminology. Typing 45 WPM/10 key by touch. Computer/ MS Office suite literate.
I'd love to talk to you if you think this position is right up your alley, and assure a prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.
Recruiter Name: Jatin RattanTitle: Senior Recruiter
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This position is located in California, United States with potential relocation and sponsorship assistance depending on candidate qualifications.
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