Job Description
Job Summary You will act as a primary resource supporting the prior authorization request process, ensuring all requests are accurately documented and adjudicated within contractual timelines. Operating primarily within utilization management (UM) systems, you will manage a steady flow of out-of-network authorizations, verify eligibility, and occasionally coordinate directly with providers to clarify clinical information. Key Responsibilities Process and document authorization requests, researching necessary medical history, diagnosis, and prognosis for clinical reviewers. Verify member insurance coverage, service eligibility, and benefits using internal system tools. Enter and maintain accurate tracking data within the utilization management system to ensure timely case resolution. Communicate effectively with providers to clarify out-of-network information. Adapt to a dynamic daily workflow, managing front-loaded assignments and incoming tasks while meeting target production requirements. Candidate Requirements Education: High School diploma or GED required (Associate degree or relevant certificate preferred). Experience: 1 to 2 years of minimum experience in healthcare or health insurance required (candidates without this experience will not be considered). Skills: Prior authorization, concurrent review, or intake experience. Attributes: data awareness, productivity mindset, and the ability to comfortably navigate frequent workflow changes.
salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
Process and document authorization requests, researching necessary medical history, diagnosis, and prognosis for clinical reviewers.
Verify member insurance coverage, service eligibility, and benefits using internal system tools.
Enter and maintain accurate tracking data within the utilization management system to ensure timely case resolution.
Communicate effectively with providers to clarify out-of-network information.
Adapt to a dynamic daily workflow, managing front-loaded assignments and incoming tasks while meeting target production requirements.
Skills
- researching network options
- Data awareness
- intake experience
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.
Job Tags
Hourly pay, Permanent employment, Temporary work, Work experience placement, Shift work