Pharmacy Prior Authorization Senior Representative – CarepathRX – Remote

The Cigna Group•Florida, MA

3d•Remote

About The Position

The Pharmacy Prior Authorization Senior Representative obtains initial and renewal prior authorizations for Specialty Pharmacy and/or Specialty Infusion services. The role collaborates with clinicians to identify supporting medical documentation in accordance with formulary guidelines and manages quality review of requested prior authorizations. It also verifies plan eligibility, processes test claims, calculates units and quantity relative to days’ supply, and communicates with patients, prescribers, internal teams, and insurers. This position may be performed remotely or from home occasionally or permanently, subject to an internet connection through a cable broadband or fiber optic provider with speeds of at least 10 Mbps download and 5 Mbps upload.

Requirements

High school diploma or GED.
At least 2 years of prior authorization, insurance verification, or related experience in a physician practice, ancillary provider, or other relevant healthcare setting.
Knowledge of medical terminology.
Knowledge of payer websites, eligibility, and coordination of benefits.
Knowledge of plan formularies and authorization requirements.
Knowledge of pharmacy versus medical payers and authorization.
Proficient computer skills and knowledge of Microsoft Office products.
Ability to use standard software applications, including Windows and Microsoft Office Suite (Outlook, Word, and Excel).
Good verbal and written communication skills.
Good organizational skills, attention to detail, and ability to multitask.
Team-player orientation, commitment to client satisfaction and customer needs, and ability to provide customer service to internal and external customers.
Ability to maintain confidentiality of patient information.
For work at home occasionally or permanently, internet service must be cable broadband or fiber optic with at least 10 Mbps download and 5 Mbps upload speeds.

Responsibilities

Obtain initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance companies through portals, phone, and fax.
Follow up on initial and renewal authorizations in a timely manner.
Interface with other departments and identify medical documentation supporting prior authorization requests.
Notify patients, prescribers, and internal teams about insurance denials and the appeals process.
Confirm plan eligibility and process test claims.
Calculate required units and quantity in relation to days’ supply.
Prioritize and complete assigned tasks on schedule.
Respond to chat and email update requests promptly.
Use appropriate communication channels to relay problems, concerns, questions, and ideas.
Work effectively and maintain expected productivity.
Meet quality standards and demonstrate reliability, pride in performance, and follow-through on assigned tasks.
Communicate effectively and express ideas clearly.
Perform in accordance with system-wide competencies and behaviors.
Perform other duties as assigned.