prior authorization florida .

Our client is looking for a focused and organized Prior Authorization Specialist to serve as a primary resource for our authorization request process. In this role, you will be responsible for ensuring that all service requests are addressed within contractual timelines and that all necessary medical documentation is secured. You will bridge the gap between healthcare providers and clinical reviewers, ensuring that member eligibility is verified and that the documentation provided supports a timely and accurate determination. ***CANDIDATES MUST BE LOCATED IN FLORIDA TO BE CONSIDERED FOR THIS ROLE***

salary: $17 - $18 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

• Support the authorization review process by researching and documenting essential medical information (history, diagnosis, and prognosis) to assist clinical reviewers in making determinations.
• Maintain ongoing tracking and precise documentation of authorizations and referrals in accordance with company policies and regulatory guidelines.
• Use system tools to verify member insurance coverage and benefit eligibility, ensuring authorizations align with guidelines for timely payment adjudication.
• Perform high-volume data entry to update and maintain authorization requests within the Utilization Management system.
• Process service requests according to the prior authorization list and route complex cases to the appropriate clinical reviewer.
• Stay current on healthcare regulations, internal policies, and evolving authorization procedures.

Skills

Medical Terminology

HIPAA

Excel

Customer Service

Data Entry

Qualifications

Years of experience: 2 years

Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

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.