Prior Authorizations Specialist California
Our client is looking for a reliable and detail-oriented person to join their team as a Prior Authorization Representative. In this role, you will help our medical team process insurance requests to make sure patients get the healthcare services they need on time. You will be responsible for entering data, checking medical documents, and making sure all paperwork follows the right rules and deadlines. If you have a background in the medical field and are good at staying organized, we would love to hear from you. CANDIDATES MUST BE LOCATED IN THE STATE OF CALIFORNIA FOR CONSIDERATION Schedule: Tuesday - Saturday: 8:00 a.m. to 5:00 p.m.
salary: $20 - $21 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
• Support the prior authorization request lifecycle to ensure all requests are addressed accurately and within required legal and contractual timeframes.
• Perform high-volume data entry to maintain and update authorization requests within the utilization management system, ensuring information is current and accessible.
• Review medical documents received via fax and electronic systems to extract specific data points needed to build a comprehensive authorization file.
• Prepare files for the clinical review team by documenting necessary medical information, including patient history, diagnosis, and prognosis.
• Perform outreach to healthcare providers to obtain missing information or clarify request details; maintain professional verbal and written communication at all times.
• Assist the team with ongoing tracking of authorizations and referrals, ensuring all actions comply with internal policies, medical guidelines, and insurance standards.
• Create and send out official determination letters to providers and members, adhering to strict deadlines and quality standards.
The essential functions of this role include:
• working weekends
Skills
• Medical Terminology
• Medicare/Medicaid
• Data Entry
• Written Communication
• Excel
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 [email protected].
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.
Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.
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salary: $20 - $21 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
• Support the prior authorization request lifecycle to ensure all requests are addressed accurately and within required legal and contractual timeframes.
• Perform high-volume data entry to maintain and update authorization requests within the utilization management system, ensuring information is current and accessible.
• Review medical documents received via fax and electronic systems to extract specific data points needed to build a comprehensive authorization file.
• Prepare files for the clinical review team by documenting necessary medical information, including patient history, diagnosis, and prognosis.
• Perform outreach to healthcare providers to obtain missing information or clarify request details; maintain professional verbal and written communication at all times.
• Assist the team with ongoing tracking of authorizations and referrals, ensuring all actions comply with internal policies, medical guidelines, and insurance standards.
• Create and send out official determination letters to providers and members, adhering to strict deadlines and quality standards.
The essential functions of this role include:
• working weekends
Skills
• Medical Terminology
• Medicare/Medicaid
• Data Entry
• Written Communication
• Excel
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 [email protected].
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.
Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.
Apply tot his job
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