Hybrid Pharmacy Prior Authorization Specialist

Elevance Health, Inc.; St. Louis (MO); Hybrid; USD 60,000 - 80,000; Full time

Job summary

BioPlus Specialty Pharmacy is seeking a Pharmacy Prior Authorization Specialist to manage and administer prior authorization requests for patients whose health plans require authorizations for various therapies. The role emphasizes accuracy, documentation, and collaboration.

This hybrid position requires in-office presence 1-2 days per week with flexible options to support productivity and work-life balance, and candidates outside commuting distance may be considered with accommodations.

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.

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.
• 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 as needed to obtain demographic information or medical data.

Skills

Specialty pharmacy experience

Medical terminology

Prior Authorization experience

Critical thinking

Education

HS diploma or GED

Job description

BioPlus Specialty Pharmacy is seeking a Pharmacy Prior Authorization Specialist to manage and administer prior authorization requests for patients whose health plans require authorizations for various therapies. The role emphasizes accuracy, documentation, and collaboration.

This hybrid position requires in-office presence 1-2 days per week with flexible options to support productivity and work-life balance, and candidates outside commuting distance may be considered with accommodations.