Hybrid Authorization Specialist II - Specialty Pharmacy

Elevance Health; Harvey (LA); Hybrid; USD 23,000 - 41,000; Full time

Job summary

Elevance Health's BioPlus Specialty Pharmacy is hiring an Authorization Representative II to handle prior authorization requests for patients under various health plans. The role blends in-office collaboration 1–2 days per week with flexible remote work to support productivity and quality service.

You will review information, assist with medical necessity documentation, and coordinate with payors and physicians.

Qualifications

• Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations.
• Minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines.

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.

Skills

Prior authorizations

Medicare/Medicaid

Pharmacy operations

Education

HS diploma or GED

Job description

Elevance Health's BioPlus Specialty Pharmacy is hiring an Authorization Representative II to handle prior authorization requests for patients under various health plans. The role blends in-office collaboration 1–2 days per week with flexible remote work to support productivity and quality service.

You will review information, assist with medical necessity documentation, and coordinate with payors and physicians.