Authorization Specialist (Remote - FL)

BC Forward is looking for Authorization Specialist II (Remote) in Florida

About BCforward

Founded in 1998, BCforward is a Black-owned global leader in workforce management and digital product delivery solutions, headquartered in Indianapolis, IN. With a worldwide team of over 6,000 consultants, BCforward is dedicated to empowering human potential through its core values: People-Centricity, Excellence, and Diversity.

As an industry pioneer, BCforward provides a best-in-class workplace, fostering a culture of accountability, innovation, and optimism. Committed to equal opportunity employment, the company champions diversity and inclusion, striving to create a positive impact for its clients, employees, and communities.

Position Title: Authorization Specialist II (Remote)

Locations: Remote - FL (Need Locals)

Anticipated Start Date: 2/24

Expected Duration: 2 months

Job Type: Contract with possible extension

Timings: Monday – Friday 9:00 AM – 6:00 PM

Pay Rate: $19.00/hr. on W2.

Need: Min 2yrs of healthcare experience with TRUCARE Desired and Omni, Servicenow are preferred.

Position Purpose
The Prior Authorization Specialist serves as a key resource in supporting the prior authorization request process, ensuring that all requests are processed within the contractual timeline. This role supports the utilization management team by documenting authorization requests, obtaining accurate and timely documentation, and ensuring healthcare eligibility and access for members.Key Responsibilities

• Act as a support resource for the prior authorization process, maintaining ongoing tracking and accurate documentation of authorizations and referrals in alignment with established policies and guidelines.
• Research and document required medical information, such as patient history, diagnosis, and prognosis, and route to the appropriate clinical reviewer for determination.
• Verify member insurance coverage and service or benefit eligibility using system tools, ensuring authorization requests align with guidelines for timely adjudication and payment.
• Perform data entry to update and maintain authorization requests in the utilization management system.
• Process authorization requests for services based on the prior authorization list and route them to the appropriate clinical reviewer for evaluation.
• Stay informed on healthcare policies, authorization processes, and procedural updates.
• Perform other duties as assigned, complying with all organizational policies and standards.

Day-to-Day Responsibilities

• Serve as part of the Escalation and Correction Team, responsible for addressing and resolving market complaints, VP complaints, and other escalated issues.
• Research and resolve issues by identifying discrepancies such as incorrect codes, authorization errors, or other inaccuracies.
• Receive assigned tasks from a queue, analyze the issue, and execute necessary corrections efficiently and accurately.
• Rebuild and correct inaccurate documents, ensuring all details are accurate, and return them to the original submitter for resolution.
• Work across three primary platforms, including ServiceNow, to manage and track tasks.

Required Skills/Experience

• Customer Service Experience in Healthcare:
• Proven ability to work with multiple teams and departments to complete thorough research, identify issues, and provide effective solutions.

Preferred Skills/Experience

• TruCare (Highly Preferred):
• Proficiency with TruCare is a significant advantage and is more essential than preferred.
• Omni:
• Experience with Omni, a customer service tool, is an asset.
• ServiceNow:
• Familiarity with ServiceNow for task and issue management is preferred.

Education Requirements

• Required: High school diploma or GED.
• Preferred: Additional education or certifications relevant to healthcare or customer service are a plus.

Software Skills Required

• TruCare (Highly Required): Extensive experience is strongly preferred for success in this role.

Performance Expectations & Metrics

• Focus on Medicaid corrections, specifically transitioning to support all states, starting with Florida Medicaid.
• Maintain a consistent production rate, completing between 30–50 corrections/escalations per day.
• Ensure tasks are handled with precision and within established timelines to uphold service quality and member satisfaction.

First Day Overview

• IT Training: Setup and familiarization with the necessary systems and tools, including ServiceNow and other platforms.
• Compliance Training: Understanding policies, procedures, and standards to ensure adherence to organizational and state regulations.
• Centene University: Access to training resources and programs to support learning and development.

Education & Experience

• High School Diploma or GED required.
• 1–2 years of relevant experience required.

Preferred Skills & Knowledge

• Familiarity with medical terminology and insurance processes.
• Strong attention to detail and organizational skills.
• Ability to work effectively in a fast-paced environment, adhering to deadlines.
• Proficiency in utilizing system tools and databases for documentation and tracking.

Job Types: Full-time, Contract

Pay: $19.00 per hour

Expected hours: 40 per week

Experience:

• TRUCARE: 1 year (Required)
• Prior Authorization: 1 year (Required)

Location:

• Florida (Required)

Work Location: Remote

Salary : $19