Authorization Representative II – BioPlus Specialty Pharmacy

Elevance Health•Lake Mary, FL

3d•Hybrid

About The Position

The Authorization Representative II at BioPlus Specialty Pharmacy administers prior authorization requests for patients whose health plans require drug prior authorizations for different therapy types. This hybrid position is based at 3200 Lake Emma Road in Lake Mary, Florida, and requires working in the office one to two days per week. Applicants must live within a reasonable commuting distance unless an accommodation is granted as required by law. The role reviews prior authorization information for accuracy and completeness, helps prepare medical necessity documentation, coordinates with other departments and physician offices, and documents insurer interactions. It also reviews denials and submits appeals when permitted by the payor.

Requirements

High school diploma or GED, or an equivalent combination of education and experience.
At least 2 years of experience processing pharmacy prior authorizations.
At least 1 year of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines.

Nice To Haves

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

Responsibilities

Review prior authorization information for accuracy and completeness, ensuring supporting documents are present and meet company standards.
Assist with completing 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 as permitted by the payor.
Contact physician offices as needed to obtain demographic information or medical data.