authorization specialist ii.

Role Overview We are seeking a detail-oriented professional to support our Utilization Management team. In this role, you will act as a key resource in the prior authorization process, ensuring all requests are documented accurately and addressed within contractual timelines to support member healthcare eligibility and access. Key Responsibilities Process and route prior authorization requests for services to appropriate clinical reviewers based on established guidelines. Research and document necessary medical information, including history, diagnosis, and prognosis, to support the clinical review process. Verify member insurance coverage and benefit eligibility using system tools to ensure timely adjudication for payment. Perform data entry to accurately maintain and update authorization requests within the utilization management system. Maintain ongoing tracking of authorizations and referrals in accordance with company policies and procedures. Remain up-to-date on healthcare regulations, authorization workflows, and compliance standards. Qualifications & Skills Experience: 1–2 years of related experience in healthcare customer service, authorizations, and compliance. Technical Proficiency: command of the Microsoft Office Suite, with specific expertise in Excel (navigating and managing spreadsheets) and Microsoft Teams. Core Competencies: Excellent customer service skills, high attention to detail, and a understanding of healthcare prior authorizations.

salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

Process and route prior authorization requests for services to appropriate clinical reviewers based on established guidelines.
Research and document necessary medical information, including history, diagnosis, and prognosis, to support the clinical review process.
Verify member insurance coverage and benefit eligibility using system tools to ensure timely adjudication for payment.
Perform data entry to accurately maintain and update authorization requests within the utilization management system.
Maintain ongoing tracking of authorizations and referrals in accordance with company policies and procedures.
Remain up-to-date on healthcare regulations, authorization workflows, and compliance standards.




Skills

Microsoft Experience

Customer Service

Authorizations and Compliance

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.