Authorization Representative II

Elevance Health • Lake Mary, FL

1d • Hybrid

About The Position

Authorization Representative II Location: Lake Mary, Florida Shift: Monday-Friday, 11:00am-8:00pm Hybrid 1: 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. 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. The Authorization Representative II is responsible for the administration of prior authorization requests for patients whose health plan requires drug prior authorizations for different therapy types.

Requirements

• Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations, and a minimum of 1 year of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

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

Responsibilities

• Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards.
• Assists with the completion of medical necessity documentation to expedite approvals and ensures that appropriate follow up is performed.
• Collaborates with other departments to assist in obtaining prior authorizations/appeals.
• Documents insurance company interactions and all prior authorization information in the system.
• Reviews insurance denials and submits appeals as permitted by payor.
• Contacts physician offices as needed to obtain demographic information or medical data.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED