Hybrid Pharmacy Prior Authorization Specialist

Elevance Health; Florida; Hybrid; USD 50,000 - 70,000; Full time

Job summary

BioPlus Specialty Pharmacy, part of the Elevance Health family, is seeking a Pharmacy Prior Authorization Specialist to manage prior authorization requests across therapy types for patients whose health plans require approvals. This hybrid role combines in-office collaboration 1–2 days per week with remote work to support productivity and work-life balance.

The specialist will review requests for accuracy, complete medical necessity documentation, and coordinate with physicians and payers to

Qualifications

• HS diploma or GED with at least 2 years of pharmacy prior authorization experience.
• At least 1 year of Medicare/Medicaid and Managed Care reimbursement knowledge.

Responsibilities

• Reviews accuracy and completeness of prior authorization information and ensures documents meet standards.
• Assists with medical necessity documentation to expedite approvals and ensure follow-up.
• Collaborates with other departments to assist in obtaining prior authorizations/appeals.
• Documents insurance company interactions and all prior authorization information in the system.
• Reviews insurance denials and submits appeals as permitted by payor.
• Contacts physician offices to obtain demographic information or medical data.

Skills

Pharmacy prior authorizations

Medicare/Medicaid knowledge

Medical terminology

Education

HS Diploma or GED

Job description

BioPlus Specialty Pharmacy, part of the Elevance Health family, is seeking a Pharmacy Prior Authorization Specialist to manage prior authorization requests across therapy types for patients whose health plans require approvals. This hybrid role combines in-office collaboration 1–2 days per week with remote work to support productivity and work-life balance.

The specialist will review requests for accuracy, complete medical necessity documentation, and coordinate with physicians and payers to