Oncology Authorization Specialist II (Hybrid)

Elevance Health; Florida; Hybrid; USD 48,000 - 64,000; Full time

Benefits offered by this job

Hybrid work arrangement

Job summary

BioPlus Specialty Pharmacy, part of Elevance Health, seeks an Authorization Representative II - Oncology to manage prior authorizations for oncology therapies. You will ensure documentation accuracy, support medical necessity submissions, and coordinate with physicians and payors to expedite approvals.

The role emphasizes collaboration with multiple departments, tracking interactions in the system, and addressing denials through permitted appeals while maintaining compliance with payer

Qualifications

• HS diploma or GED required with 2+ years in pharmacy prior authorizations.
• Knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines.
• Strong attention to detail and ability to document accurately.

Responsibilities

• Review accuracy of prior authorization information and ensure documents meet standards.
• Assist with medical necessity documentation to expedite approvals and follow up.
• Collaborate with other departments to obtain prior authorizations/appeals.
• Document insurance interactions and all prior authorization data in the system.
• Review denials and submit appeals as permitted by payor.
• Contact physician offices to obtain needed information.

Skills

Prior authorization processing

Medicare/Medicaid knowledge

Medical terminology

Documentation & follow-up

Education

HS diploma or GED

Tools

EMR systems

Job description

BioPlus Specialty Pharmacy, part of Elevance Health, seeks an Authorization Representative II - Oncology to manage prior authorizations for oncology therapies. You will ensure documentation accuracy, support medical necessity submissions, and coordinate with physicians and payors to expedite approvals.

The role emphasizes collaboration with multiple departments, tracking interactions in the system, and addressing denials through permitted appeals while maintaining compliance with payer