Acts as a resource supporting the prior authorization request process to ensure authorization requests are addressed within contractual timelines. Supports the utilization management team by documenting authorization requests and obtaining accurate, timely documentation for services related to members' healthcare eligibility and access.
Key responsibilities include:
- Assist the utilization management team by maintaining tracking and documentation for authorizations and referrals in accordance with policies and guidelines
- Support the authorization review process by researching and documenting medical information such as history, diagnosis, and prognosis for clinical reviewer determination
- Verify member insurance coverage and service or benefit eligibility using system tools
- Enter and update authorization requests in the utilization management system
- Process authorization requests according to the insurance prior authorization list and route them to the appropriate clinical reviewer
- Stay current on healthcare authorization processes, policies, and procedures
- Perform other duties as assigned
- Comply with all policies and standards
High school diploma or GED required.
1-2 years of related experience required.
Preferred knowledge of medical terminology and insurance.
Qualified candidates must be located in Missouri and authorized to work in the U.S. without current or future employment-based visa sponsorship.
Competitive pay
Health insurance
401(k) and stock purchase plans
Tuition reimbursement
Paid time off and holidays
Flexible work schedules with remote, hybrid, field, or office options
Additional incentives may be available based on eligibility
Location
Missouri, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
3 weeks ago