Authorization Representative II - BioPlus Specialty Pharmacy
Elevance Health, Indianapolis, IN, United States
Authorization Representative II - BioPlus Specialty Pharmacy
Location:
This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The
Authorization Representative II
is responsible for the administration of prior authorization requests for patients whose health plan requires drug prior authorizations for different therapy types.
How you will make an impact:
Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards.
Assists with the completion of medical necessity documentation to expedite approvals and ensures that appropriate follow up is performed.
Collaborates with other departments to assist in obtaining prior authorizations/appeals.
Document insurance company interactions and all prior authorization information in system.
Reviews insurance denials and submit appeals as permitted by payor.
Contacts physician offices as needed to obtain demographic information or medical data.
Minimum Requirements:
Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations, and a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Certified Pharmacy Technician highly desired.
Specialty pharmacy experience highly preferred.
Medical terminology training is preferred.
Experience with Prior Authorizations, Denials and Appeals highly desired.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
#J-18808-Ljbffr
Location:
This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The
Authorization Representative II
is responsible for the administration of prior authorization requests for patients whose health plan requires drug prior authorizations for different therapy types.
How you will make an impact:
Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards.
Assists with the completion of medical necessity documentation to expedite approvals and ensures that appropriate follow up is performed.
Collaborates with other departments to assist in obtaining prior authorizations/appeals.
Document insurance company interactions and all prior authorization information in system.
Reviews insurance denials and submit appeals as permitted by payor.
Contacts physician offices as needed to obtain demographic information or medical data.
Minimum Requirements:
Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations, and a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Certified Pharmacy Technician highly desired.
Specialty pharmacy experience highly preferred.
Medical terminology training is preferred.
Experience with Prior Authorizations, Denials and Appeals highly desired.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
#J-18808-Ljbffr