Healthcare Authorization Specialist

Healthcare Authorization Specialist

Location: Fully Remote, Texas

Pay: $19.00/hour

Schedule: Monday-Friday, 8:00 AM-5:00 PM CST

Employment Type: Initial W2 Assignment with potential for extension or conversion to FTE based on business needs

Job Overview

This role supports the authorization intake function for a large managed care organization serving Texas Medicaid members. The team receives, reviews, validates, and creates prior authorization requests across multiple Medicaid lines of business, including STAR, STAR+, CHIP, STAR Kids, and STAR Health. Authorization Specialists help ensure requests are accurately entered, properly routed, and processed within required turnaround times to support timely access to care.

The Authorization Intake team works in a fast-paced and collaborative environment focused on quality, compliance, productivity, and customer service. Specialists work closely with clinical review, determinations, correspondence, provider relations, and leadership teams while managing authorization inventory and responding to changing business needs.

Key Responsibilities

• Receive, review, and validate prior authorization requests for multiple Texas Medicaid programs.
• Research member and provider information to ensure authorization requests are complete and accurate.
• Review requests for required documentation and information.
• Create and build authorizations in the appropriate systems.
• Conduct provider outreach to obtain missing information or documentation.
• Route authorization requests to the appropriate teams based on established workflows.
• Document processing activities and provider communications accurately.
• Manage worklist inventory and prioritize requests to meet regulatory and business turnaround time requirements.
• Support transition-of-care activities and authorization-related special initiatives.
• Assist with provider education and inquiries related to authorization processing.
• Work collaboratively with clinical reviewers, provider relations, correspondence, and operations leadership.
• Follow applicable healthcare regulations, business requirements, and department procedures.
• Maintain productivity and quality standards while minimizing processing errors and preventing overdue requests.

Qualifications

• High school diploma or GED required.
• 1-2 years of prior authorization experience required.
• Experience with provider outreach.
• Experience with healthcare insurance verification.
• Knowledge of ICD-10 codes.
• Knowledge of CPT codes.
• Healthcare insurance, managed care, Medicaid, or utilization management experience is preferred.