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.” ============== "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 Health plan or business unit Team culture Surrounding team & key projects Purpose of this team Reason for the request Motivators for this need Any additional upcoming hiring needs? Sunshine State Health Plan 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 Typical Day in the Role Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description 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 What makes this role interesting? Points about team culture Competitive market comparison Unique selling points Value added or experience gained 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 Years of experience required Disqualifiers Best vs. average Performance indicators Must haves: 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 Customer Service Experience along the same lines as the field Authorizations and Compliance experience Nice to haves: Healthcare background Trucare (Centene program) Disqualifiers: Not knowing how to navigate through Microsoft office Performance indicators: Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection 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 Second touchpoint for feedback Interview Information Onboard Process and Expectations 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 Background Check Requirements (List DFPS or other specialty checks here) n/a Do you have any upcoming PTO? March 25 - 30