Pyramid Consulting
BusinessOperations - Authorization Specialist II
Pyramid Consulting, California, Missouri, United States, 65018
BusinessOperations - Authorization Specialist II
Job ID:
25-90597 Pay Range:
$22.00/hr $23.00/hr Contract Length:
6 months (long?term potential) Location:
California (Remote) Key Responsibilities: 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 the 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.
Key Requirements and Technology Experience: Authorization Claims Health Insurance Claims experience / review claims Authorization experience / creating Authorization Validating dates meeting compliance Experience with HMO / PPO / Medicaid insurance plans, appeals experience. HS Diploma / GED.
Employee Benefits:
Health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #J-18808-Ljbffr
Job ID:
25-90597 Pay Range:
$22.00/hr $23.00/hr Contract Length:
6 months (long?term potential) Location:
California (Remote) Key Responsibilities: 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 the 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.
Key Requirements and Technology Experience: Authorization Claims Health Insurance Claims experience / review claims Authorization experience / creating Authorization Validating dates meeting compliance Experience with HMO / PPO / Medicaid insurance plans, appeals experience. HS Diploma / GED.
Employee Benefits:
Health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #J-18808-Ljbffr