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BusinessOperations - Authorization Specialist II - J00904
Mindlance
- 🇺🇸 United States
- Remote
- 1 week ago
- prior authorization
- medical terminology
- Excel
1 week ago
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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| "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" | ||
| Story Behind the Need – Business Group & Key Projects | ||
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| Typical Day in the Role | ||
| Remote – FL – must reside in Florida Monday – Friday 8 am – 5 pm (1) hour lunch Family style environment Remote work | |
| Compelling Story & Candidate Value Proposition | ||
| 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 | |
| Candidate Requirements | ||
| Education/Certification | Required: High School Diploma | Preferred: n/a |
| Licensure | Required: n/a | Preferred: n/a |
| Must haves:
Performance indicators: | |
| 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 | ||
| Projected HM Candidate Review Date: | 24 – 48 hours |
| Number and Type of Interviews: | Teams | |
| Extra Interview Prep for Candidate: | n/a | |
| Required Testing or Assessment (by Vendor): | n/a | |
| Manager Communication Preferences & Next Steps | ||
| n/a | |
| March 25 - 30 |
BusinessOperations - Authorization Specialist II - J00904 · Mindlance