Coverage Determination Representative

As one of the largest and most respected specialty pharmacies, BioPlus creates a meaningful difference to our patients, prescribers, payers, and pharmaceutical partners. Our 2- Hour Patient Acceptance Guarantee gives a quick response to prescribers and patients for critical, time‑sensitive treatments. As we continue to grow, we need exceptionally talented, bright, and driven people. If you would like to help us continue to be the innovative leader in our industry, this is your chance to join our team. Job Description The Coverage Determination Rep I is responsible for gathering all information required on an authorization, completing, and submitting the authorization form to insurance company and for all follow up phone calls and documentation of these authorizations. Responsibilities Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers. Review prescription for accuracy of prescribed treatment regimen prior to submission of authorization. Gather all necessary information from prescriber offices to complete authorization forms. Notify appropriate staff of approved/denied medications. Process/reverse online claims to confirm authorization outcome. Complete status check with insurance company regarding receipt and outcome of prior authorization. Perform calls to prescriber office for status of authorization or request for additional information. Responsible for all documentation of authorization statuses into CPR+ progress notes. Update sales staff with pertinent information. Participate and perform other duties as assigned by leadership. Skills & Abilities Professional appearance. Work cooperatively and be a liaison between departments when needed. Knowledge of standard medical terminology and pharmacy prior authorization and appeal/denial processes desired. Demonstrate excellent oral, presentation, and written communication skills. Demonstrate proficiency in the use of MS Office software, which includes Excel, Word, and Outlook. Demonstrate the BioPlus C.A.R.T. values. Qualifications High School Diploma or Equivalent. At least 1 year experience working with pharmacy prior authorizations, or pharmacy billing. Specialty pharmacy experience preferred. Additional Information BioPlus offers competitive compensation packages including health care, 401(k), growth potential, and a challenging and exciting work environment. BioPlus is an Equal Opportunity Employer. #J-18808-Ljbffr VERA Security, Inc.