Authorization Representative II

Elevance Health•St. Louis, MO

2d•Hybrid

About The Position

The Authorization Representative II is responsible for the administration of prior authorizations requests for patients whose health plan requires drug prior authorizations for different therapy types. This role requires associates be in the 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. 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.

Requirements

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

Nice To Haves

Specialty pharmacy experience highly preferred.
Medical terminology training preferred.
Prior Authorization experience preferred.
Certified Pharmacy Tech preferred.
Insurance call center experience 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.
Document insurance company interactions and all prior authorization information in system.
Reviews insurance denials and submit appeals as permitted by payor.
Contacts physician offices as needed to obtain demographic information or medical data.