Authorization Representative II - Oncology | BioPlus Specialty Pharmacy

Elevance Health; Florida; Hybrid; USD 48,000 - 64,000; Full time

Benefits offered by this job

Hybrid work arrangement

Job summary

BioPlus Specialty Pharmacy, part of Elevance Health, seeks an Authorization Representative II - Oncology to manage prior authorizations for oncology therapies. You will ensure documentation accuracy, support medical necessity submissions, and coordinate with physicians and payors to expedite approvals.

The role emphasizes collaboration with multiple departments, tracking interactions in the system, and addressing denials through permitted appeals while maintaining compliance with payer

Qualifications

• HS diploma or GED required with 2+ years in pharmacy prior authorizations.
• Knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines.
• Strong attention to detail and ability to document accurately.

Responsibilities

• Review accuracy of prior authorization information and ensure documents meet standards.
• Assist with medical necessity documentation to expedite approvals and follow up.
• Collaborate with other departments to obtain prior authorizations/appeals.
• Document insurance interactions and all prior authorization data in the system.
• Review denials and submit appeals as permitted by payor.
• Contact physician offices to obtain needed information.

Skills

Prior authorization processing

Medicare/Medicaid knowledge

Medical terminology

Documentation & follow-up

Education

HS diploma or GED

Tools

EMR systems

Job description

Authorization Representative II - Oncology | BioPlus Specialty Pharmacy

Location: 3200 Lake Emma Rd, Lake Mary, FL 32746

Schedule: Monday - Friday

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.

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.

TheAuthorization 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:

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

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 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.