Elevance Health
Prior Authorization Rep I (Specialty Pharmacy)
This job is now closed
Job Description
- Req#: JR93227
Enters re-authorizations into the portal and ensures accurate completion of re-authorization forms.
Submits completed re-authorization forms to the appropriate insurance plans.
Maintains log of all re-authorizations submitted.
Follows up with the patient's insurance company or physician office by phone, email or spreadsheets on all submitted re-authorization for patient approval/denial status.
Requires a HS diploma or GED and a minimum of 1 year of experience processing pharmacy prior authorizations.
Specialty pharmacy experience highly preferred.
Experience completing prior authorization, start to finish, strongly preferred.
Experience completing prior authorization with clinical information from the patient progress notes preferred.
Experience submitting the prior authorization to the patient plan.
Experience following up with approvals and denials.
Experiencing reading scripts.
Test Claim experience preferred.
Familiarity with multiple health plans (Optum/CareMark/Alliance RX/etc).
Microsoft Outlook suite experience preferred.
Position Title:
Prior Authorization Rep I (Specialty Pharmacy)Job Description:
Be Part of an Extraordinary Team
BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies. Together, CarelonRx and BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.
LOCATION: This position is onsite at our office in Altamonte Springs, FL. You must commute to this location on a daily basis.
HOURS: 10:00 am - 7:00pm, Monday through Friday
The Authorization Representative I is responsible for the completion and submission of appropriate forms for patients whose health plan requires drug re-authorizations for different therapy types.
How you will make an impact:
Required Qualifications
Preferred Qualifications
Job Level:
Non-Management Non-ExemptWorkshift:
1st Shift (United States of America)Job Family:
MED > Medical Ops & Support (Non-Licensed)Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 ability@icareerhelp.com for assistance.
About the company
Elevance Health, Inc. is an American health insurance provider.