Authorization Representative II - BioPlus Specialty Pharmacy

Elevance Health (Anthem); Florida; Hybrid; USD 42,000 - 54,000; Full time

Job summary

Elevance Health is seeking an Authorization Representative II for BioPlus Specialty Pharmacy in Lake Mary, FL. This hybrid role requires in-office presence 1–2 days weekly with flexibility for remote work and potential alternative locations within commuting distance.

The position focuses on reviewing prior authorization data, assisting with medical necessity documentation, and coordinating with departments to obtain approvals. A HS diploma and 2+ years of authorization experience are required.

Qualifications

• Requires HS diploma or GED with 2+ years of prior authorization experience.
• Knowledge of Medicare, Medicaid and managed care reimbursement guidelines preferred.
• Experience processing pharmacy prior authorizations is required.

Responsibilities

• Review accuracy and completeness of prior authorization information.
• Assist with medical necessity documentation to expedite approvals.
• Collaborate with other departments to obtain authorizations/appeals.
• Document insurance interactions and all prior authorization data in system.
• Review denials and submit appeals as permitted by payor.
• Contact physicians to obtain demographics or medical data.

Skills

Specialty pharmacy experience

Medical terminology training

Education

HS diploma or GED

Job description

Position Title: Authorization Representative II - BioPlus Specialty Pharmacy

Job Description: Authorization Representative II - BioPlus Specialty Pharmacy

Location(s): 3200 Lake Emma Rd, Lake Mary, FL 32746

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.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

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.

Responsibilities

• 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.

Job Level

Non-Management Non-Exempt

Job Family

CUS > Care Support

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