Authorization Representative II - BioPlus Specialty Pharmacy

Elevance Health; Quinte West; Hybrid; CAD 35,000 - 58,000; Full time

Job summary

Elevation Health BioPlus Specialty Pharmacy is seeking an Authorization Representative II to manage prior authorization requests for patients whose plans require authorizations across various therapy types. This role offers hybrid work with in-office presence 1–2 days per week and flexibility for alternating locations for commuting candidates.

You will verify information, assist with medical necessity documentation, coordinate with other departments for authorizations/appeals, and log all

Qualifications

• HS diploma or GED with 2 years of pharmacy prior authorization experience.
• Minimum 1 year experience with Medicare/Medicaid and Managed Care guidelines.
• Equivalent combination of education and experience acceptable.

Responsibilities

• Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet standards.
• Assists with the completion of medical necessity documentation to expedite approvals and ensures follow up is performed.
• Collaborates with other departments to obtain prior authorizations/appeals.
• Documents insurance interactions and all prior authorization information in the system.
• Reviews insurance denials and submits appeals as permitted by payor.
• Contacts physician offices as needed to obtain demographic information or medical data.

Skills

Prior authorizations

Medicare/Medicaid knowledge

Pharmacy terminology

Education

HS diploma or GED

Job description

Anticipated End Date:

2026-09-29

Position Title:

Authorization Representative II - BioPlus Specialty Pharmacy

Job Description:

Authorization Representative II – BioPlus Specialty Pharmacy

Anticipated job Posting End Date: 9/29/2026

Locations:

3200 Lake Emma Rd, Lake Mary, FL 32746; 100 S 4th St, St. Louis, MO 63102; 2731 Manhattan Blvd, Harvey, LA 70058; 700 Broadway Denver, CO 80203

Schedule:

Monday - Friday, 8:00-5:00

Hybrid:

This role requires associates to be in-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 if candidates reside within a commuting distance from an office.

BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.

The Authorization Representative II will be responsible for the administration of prior authorizations requests for patients whose health plan requires drug prior authorizations for different therapy types.

How you will make an impact:

• 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.

Minimum Qualifications:

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

Preferred Skills, Capabilities and Experiences:

• Specialty pharmacy experience highly preferred.
• Medical terminology training preferred.
• Oncology experience preferred.

For candidates working in person or virtually in the below location, the salary* range for this specific position is $17.89 to $29.52.

Location:

Colorado

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:

Non-Management Non-Exempt

Job Family:

CUS > Care Support

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.