Authorization Research Specialist III

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Resolves time-sensitive authorization issues that impact claim denials, reconsiderations, or appeals. Researches root causes for delays in authorization process and ensures all requirements are completed in accordance with guidelines.

• Ensures all assigned authorization issues and/or errors are resolved within appropriate the time frame to avoid interference with the processing of claims
• Identifies claim issues related to authorizations that impact the resolution of claims and escalates as appropriate
• Performs outreach, researches, and resolves all open or pending authorization issues that impact claim denials, reconsiderations, or appeals
• Reviews authorization and system errors and resolves in a timely manner to ensure processing requirements are in accordance with guidelines
• Provides reporting on authorization issues and trends identified related to claim denials, reconsiderations, and appeals
• Reviews check runs for claims and system configuration accuracy
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires a High School diploma or GED. Requires 2 - 4 years of related experience. 2+ years experience in healthcare authorizations, denials, medical claims, coding and/or collections preferred. Knowledge of Medicare and Medicaid regulations, insurance processes, medical terminology and payor compliance rules preferred.

Pay Range: $22.50 - $38.02 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act