Hybrid Prior Authorization Specialist II

Elevance Health; Denver (CO); Hybrid; USD 23,000 - 41,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

BioPlus Specialty Pharmacy, part of the Elevance Health family, is hiring an Authorization Representative II in a hybrid Colorado role. The position focuses on administering prior authorization requests for patients whose health plans require them.

You will work across departments to secure approvals and manage documentation throughout the process. Location-based salary details apply, with a hybrid model: in-office 1–2 days weekly.

Qualifications

• HS diploma or GED with 2 years experience processing pharmacy prior authorizations.
• At least 1 year applying Medicare, Medicaid and Managed Care reimbursement guidelines.
• Equivalent combinations of education and experience considered.

Responsibilities

• Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company 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 system.
• Reviews insurance denials and submits appeals as permitted by payor.
• Contacts physician offices as needed to obtain demographic information or medical data.

Skills

Prior authorizations

Medical terminology

Attention to detail

Communication

Education

HS diploma or GED

Job description

BioPlus Specialty Pharmacy, part of the Elevance Health family, is hiring an Authorization Representative II in a hybrid Colorado role. The position focuses on administering prior authorization requests for patients whose health plans require them.

You will work across departments to secure approvals and manage documentation throughout the process. Location-based salary details apply, with a hybrid model: in-office 1–2 days weekly.