SSHP Pre-Auth Referral Specialist – Centene (Remote)
Processed and reviewed pre-authorization and referral requests by verifying member eligibility, provider credentials, and required documentation against plan rules. Entered and maintained authorization data in multiple healthcare systems and databases with accuracy and confidentiality. Ensured compliance with HIPAA and quality standards while resolving authorization discrepancies through cross-department collaboration.• Reviewed and classified request documentation for authorization decisions.• Validated eligibility and credentialing details before case handling.• Updated and tracked authorization records in internal systems.• Resolved inconsistencies by proactive problem-solving and coordination.