Pharmacy Prior Authorization Senior Representative - Freedom Fertility - Remote AZ or IL or MA

Cigna Healthcare•Boston, MA

6d•$19 - $29•Remote

About The Position

As a Pharmacy Prior Authorization Senior Representative at Freedom Fertility, you will work on a specialized, high-touch team assisting patients and supporting a specific group of clinics. The role focuses on researching benefits, obtaining prior authorizations, processing prescription orders, and communicating with internal sales teams, patients, and providers. You will use internal and external pharmacy and clinic systems to complete the prior authorization process, while providing attentive, accurate customer service. The position is remote for applicants in Arizona, Illinois, or Massachusetts. Schedules depend on location and business needs. Training is scheduled from 8:30 AM to 5:00 PM EST, Monday through Friday; the scheduled eight-hour shift is 12:30 PM to 9:00 PM EST, Monday through Friday. Weekend work may be needed. For work performed from home, internet service must be cable broadband or fiber optic with speeds of at least 10 Mbps download and 5 Mbps upload. The anticipated hourly rate is $19–$29, depending on relevant factors including experience and geographic location. The role is anticipated to be eligible for participation in an annual bonus plan. The Cigna Group offers health-related benefits beginning on the first day of employment, including medical, vision, dental, and well-being and behavioral health programs. Other stated offerings include a 401(k), company-paid life insurance, tuition reimbursement, at least 18 days of paid time off per year, paid holidays, and leaves of absence.

Requirements

High school diploma or GED.
At least 2 years of Pharmacy Technician experience.
Valid National Pharmacy Technician certification.
Valid pharmacy technician license in Arizona, Massachusetts, or Illinois.
Microsoft Office proficiency and data-entry skills.
Strong math skills related to prescription calculations.
Exceptional attention to detail, accuracy, and quality.
Excellent verbal and written communication skills.
Ability to multitask across computer- and phone-related tasks.
At least 1 year of relevant experience submitting prior authorizations using CoverMyMeds or a similar electronic prior authorization tool.
Experience with prior authorization appeals and denials.
Ability to work effectively, foster teamwork, take ownership of projects, and build strong working relationships with colleagues and customers.
Results-oriented approach, with the ability to prioritize and manage workload and meet deadlines.

Nice To Haves

Experience working with clinical EMR systems.
Experience in infertility.

Responsibilities

Enter prescriptions accurately, adjudicate claims, and resolve rejections so prescription claims are processed for accurate dispensing.
Use clinic-specific electronic medical record systems to obtain information needed for prior authorization submissions.
Follow program-specific contractual agreements and company practices.
Investigate processing and benefit inquiries from the Fertility Inside Sales team promptly and thoroughly.
Conduct insurance inquiries and benefit checks.
Submit prior authorizations, follow up, and handle appeals as needed.
Manage multiple tasks while maintaining attention to detail.
Help patients and providers understand pharmacy benefits and answer their questions.
Handle internal and external prior authorization inquiries using strong communication skills.
Participate in program-specific customer meetings and training sessions.
Participate in special projects and perform other duties related to specific contract performance.