Job Description
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 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 Candidate Requirements 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 Top 3 must-have hard skills 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
salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
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
Skills
- Customer Service
- Authorizations and Compliance
- Microsoft Excel Experience
Qualifications
- Years of experience: 1 year
- Experience level: Experienced
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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Hourly pay, Permanent employment, Temporary work, Work experience placement, Work at office, Shift work