Hybrid Authorization Specialist II — 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

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.