Prior Authorization Technician

Job Title: Prior Authorization Technician

Duration: 1 year

REMOTE – AZ Time zone preferred

Department: Managed Care – Prior Authorization

This position's starting pay is: $22/hr.

Summary:

The Prior Authorization Technician processes written requested services by providers for Medicaid Business Segment members within established timeframes, following Medicaid Business Segment criteria and guidelines.

This position also completes data entry and provider notification to ensure timely service to members.

REQUIRED QUALIFICATIONS

1. Required Work Experience

• 1 year of experience in effectively using interpersonal communication skills, especially via telephone
• 1 year of experience using electronic Care Management systems

1. Required Education

• High School Diploma or GED in general field of study

1. Required Licenses

• N/A

1. Required Certifications

• N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

• 1-2 years Prior Call Center experience preferred
• 1-2 years Medicaid/Medicare experience preferred
• 1-2 years Prior Managed Care experience preferred

1. Preferred Education

• Completion of Medical Assistant program

1. Preferred Licenses

• N/A

1. Preferred Certifications

• N/A

Job description:

• Answer inbound calls regarding authorizations within established time frame
• Document contact information in electronic care management system
• Ensure all necessary information is entered in electronic care management system
• Review and approve requests based on Medicaid Business Segment established guidelines
• Ensure requests are forwarded to correct location according to established review process
• Contact referring provider to obtain additional information needed to make determination
• Fax decisions to requesting providers
• Provide education to providers and facilities regarding proper authorization procedures and inform them of any updates as needed
• Initiate interdepartmental coordination to ensure quality and timely care for members.
• Additional duties as assigned

competencies

REQUIRED COMPETENCIES

1. Required Job Skills

• Knowledge of medical terminology
• Computer experience necessary

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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.