Prior Authorization Specialist

Company Description

Lumen Solutions Group Inc. is a technology consulting Services Company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.

Job Title: Prior Authorization Specialist

Location: 100% Remote (Must work EST hours)

Duration: 3-Month Contract

Position Summary

We are seeking a Utilization Management Coordinator to support the Utilization Management team with authorization processing, provider support, and administrative coordination activities. The ideal candidate will have experience in Utilization Management, healthcare operations, and a high-volume call center environment.

Key Responsibilities

• Process incoming faxes and authorization requests.
• Create, update, and maintain authorizations.
• Handle inbound provider calls and resolve inquiries.
• Support Utilization Management, care coordination, and utilization review activities.
• Accurately document activities and maintain records in internal systems.
• Collaborate with clinical and operational teams to ensure timely processing.
  
  

Required Qualifications

• High School Diploma or equivalent.
• 3 years of Utilization Management experience.
• 3 years of experience in healthcare claims, provider services, customer service, or administrative support.
• Previous call center experience in a high-volume environment.
• Strong communication, organizational, and multitasking skills.
  
  

Preferred Qualifications

• Experience with GuidingCare (strongly preferred).
• Experience with Facets and NICE CXone.
• Knowledge of CPT, ICD-10, and HCPCS codes.
• Experience in a managed care or health insurance environment.
  
  

Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.