Prior Authorization Representative- Evernorth- Remote
About The Position
The Prior Authorization Representative supports the authorization process for enteral services. This includes submitting new and renewal requests, following up with insurance plans, helping collect medical documents, and sharing updates with patients, prescribers, and internal teams. This role is ideal for an early career candidate who enjoys details, teamwork, problem solving, and helping patients move through the care process with less delay. 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.
Requirements
- High school diploma or GED.
- Minimum 1 year of experience in customer service, administrative support, healthcare support, insurance, call center, data entry, or a related role.
- Basic knowledge of medical terminology
- Comfort using computers and Microsoft Office applications, including Outlook, Word, and Excel.
- Clear written and verbal communication skills.
- Strong attention to detail and ability to stay organized while managing multiple tasks.
- Customer-focused mindset and ability to work well with patients, providers, and internal teams.
- Ability to handle confidential patient information with care.
Nice To Haves
- Experience in healthcare, insurance verification, prior authorization, patient access, billing, pharmacy, home infusion, or durable medical equipment (DME).
- Familiarity with payer websites, insurance eligibility, coordination of benefits, formularies, denials, or appeals.
- Experience working in a fast-paced team environment where accuracy and follow-up are important.
Responsibilities
- Submit initial and renewal prior authorization requests through payer portals, phone, fax, or other approved methods.
- Track open requests and follow up on time to help reduce delays in care.
- Review information for accuracy and completeness before sending requests to insurance plans.
- Work with clinicians and internal teams to gather documents needed to support authorization requests.
- Share clear updates with patients, prescribers, and team members about approvals, denials, or next steps.
- Respond to email, chat, and other requests in a timely and professional way.
- Manage daily tasks and priorities while meeting team quality and productivity goals.
- Keep patient information private and document work accurately.
Benefits
- Medical insurance
- Vision insurance
- Dental insurance
- Well-being and behavioral health programs
- 401(k)
- Company paid life insurance
- Tuition reimbursement
- 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Annual bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
