appeals and authorizations specialist.

Job title: appeals and authorizations specialist

Locations: tampa, florida (remote)

Posted today

Job details

Summary

• $22 - $23 per hour

• temp to perm

• high school

• category office and administrative support occupations

• reference AB_5085387

Job details

Our client seeking a detail-oriented and efficiency-driven specialist to join our dynamic Corporate Utilization Management team. In this fast-paced, high-impact role, you will be responsible for reviewing provider reconsideration claims and building the necessary authorizations for clinical determination. Supporting operations across a broad multi-state footprint, you will manage high-volume inventory, navigate multiple systems to research claim details, and ensure all authorization builds and documentation comply with state regulations and National Committee for Quality Assurance (NCQA) guidelines.

salary: $22 - $23 per hour shift: First work hours: 8 AM - 5 PM education: High School

Responsibilities

• Build & Process Authorizations: Review provider reconsideration claims received through intake portals, validate claim details across multiple applications, and accurately construct the required authorizations for clinical partner review.
• Research & Investigation: Conduct thorough research to evaluate request details, gather necessary supporting documentation, and determine appropriate follow-up actions for each case.
• Data Entry & File Tracking: Perform data entry to log, track, and process authorizations, appeals, disputes, and reconsiderations in strict accordance with regulatory and accreditation standards.
• Documentation & Correspondence: Prepare official correspondence, maintain accurate documentation files, and organize complete case packages for clinical review and reporting.
• Outreach & Trend Monitoring: Track final outcomes and conduct outreach as needed to gather status updates, determinations, and explanations to support team reporting.
• Compliance: Adhere strictly to all organizational policies, state regulations, and NCQA standards to maintain operational efficiency and timeliness.

Skills

• Prior Authorization building (2 years of experience is required)
• Utilization Management (2 years of experience is required)
• Analytical Thinking
• HIPAA

Qualifications

• Years of experience: 2 years

• 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 at randstadusa dot 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.