Authorization Representative II – 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 for different therapy types. The role reviews authorization information and supporting documents, assists with medical necessity documentation and follow-up, and works with internal departments, payors, and physician offices to support authorization and appeal processes. The position is hybrid, requiring associates to work in the Lake Mary, Florida office 1–2 days per week. Candidates must live 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, and at least 1 year of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines; or an equivalent combination of education and experience.

Nice To Haves

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

Responsibilities

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