Authorization Representative II - Oncology | BioPlus Specialty Pharmacy

Elevance Health•Lake Mary, FL

1d•Hybrid

About The Position

The Authorization Representative II administers prior authorization requests for patients whose health plans require drug prior authorizations across different therapy types. The role reviews authorization information and supporting documentation, helps prepare medical-necessity documentation, coordinates with other departments and physician offices, and documents payer interactions and authorization activity. The position is based in Lake Mary, Florida, and follows a Monday–Friday hybrid schedule requiring 1–2 days in the office each week. Candidates must be within reasonable commuting distance unless an accommodation is granted as required by law.

Requirements

High school diploma or GED, and at least 2 years of experience processing pharmacy prior authorizations, plus at least 1 year of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines; equivalent combinations of education and experience may be considered.
Must be within reasonable commuting distance of the posting location unless an accommodation is granted as required by law.

Nice To Haves

Oncology experience preferred.
Specialty pharmacy experience highly preferred.
Medical terminology training preferred.

Responsibilities

Review prior authorization information for accuracy and completeness and ensure supporting documents meet company standards.
Assist with medical-necessity documentation to expedite approvals and ensure appropriate follow-up.
Collaborate with other departments to help obtain prior authorizations and appeals.
Document insurance-company interactions and prior authorization information in the system.
Review insurance denials and submit appeals when permitted by the payer.
Contact physician offices as needed to obtain demographic information or medical data.