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. Only candidates within a reasonable commuting distance from the posting location(s) will be considered for employment, unless an accommodation is granted as required by law. How You Will Make An Impact Review accuracy and completeness of prior authorization information requested and ensure supporting documents are present and meet company set standards. Assist with the completion of medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Collaborate with other departments to assist in obtaining prior authorizations/appeals. Document insurance company interactions and all prior authorization information in the system. Review insurance denials and submit appeals as permitted by payor. Contact physician offices as needed to obtain demographic information or medical data. Minimum Requirements High school diploma or GED. Minimum of 2 years of experience processing pharmacy prior authorizations. Minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines, or equivalent combination of education and experience. 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. Professional Competencies Strong oral, written and interpersonal communication skills. Proficient problem‑solving, facilitation, 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 View email address on click.appcast.io for assistance. #J-18808-Ljbffr