Authorization Specialist II - Evernorth

The Cigna Group

4d•Remote

About The Position

The job profile for this position is Pharmacy Prior Authorization Senior Representative, which is a Band 2 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Must reside in Pennsylvania to be consider for the position. Position Summary Responsible for obtaining initial prior authorization and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services. Collaborate with clinicians regarding supporting medical documentation in accordance with formulary guidelines. Manage the quality review of requested prior authorizations. As part of Evernorth Health Services, this role supports CarepathRx within our Pharmacy and Care Delivery organization. Our team focuses on specialty pharmacy and infusion services in partnership with hospitals and health systems. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Requirements

HS diploma or GED required.
2+ years of prior authorization, insurance verification or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required.
Knowledge of medical terminology required.
Knowledge of payer websites, eligibility, coordination of benefits required.
Knowledge of plan formularies and authorization requirements required.
Knowledge of pharmacy vs medical payers and authorization required.
Proficient computer skills and Microsoft Office Products required.

Responsibilities

Obtains initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance companies via portal, phone, fax.
Ensures initial and renewal authorizations are followed up on in a timely manner.
Interface with other departments and identify medical documentation in support of prior authorization requests.
Notifies the patient, prescriber and internal teams of insurance denial/appeals process.
Confirms plan eligibility and processes test claims.
Calculates required units and quantity vs day supply.
Prioritizes and completes assigned tasks on schedule.
Responds to chat/email update requests timely.
Utilizes appropriate communication lines in relaying problems, concerns, questions, and ideas.
Demonstrates the ability to work effectively and maintain expected productivity.
Meets quality standards, shows pride in performance, and demonstrates reliability and follow through on all assigned tasks.
Demonstrates ability to communicate effectively and express ideas clearly.
Performs in accordance with system-wide competencies/behaviors.
Performs other duties as assigned.