Pharmacy Prior Authorization Senior Representative - CarepathRX - Remote

Cigna Healthcare; Florida; Remoto; USD 55.000 - 75.000; Tempo pieno

Descrizione del lavoro

The Cigna Group is seeking a Pharmacy Prior Authorization Senior Representative in Florida to manage initial and renewal authorizations for Specialty Pharmacy and Infusion services. You will collaborate with clinicians, prepare supporting documentation, and monitor the quality review of requests.

Responsibilities include timely follow-up, payer communications, and ensuring eligibility and claims processing, with strong emphasis on accuracy and patient confidentiality.

Competenze

• Team-oriented with focus on client satisfaction.
• Strong written and verbal communication skills.
• Confidential handling of patient information and data privacy.
• Proficient with Windows OS and MS Office (Outlook, Word, Excel).
• Ability to multitask and stay organized in a fast-paced environment.

Mansioni

• Obtain initial and renewal prior authorizations for Specialty Pharmacy/Infusion from insurers via portal, phone, or fax.
• Ensure timely follow-up on authorizations.
• Interface with internal teams to gather supporting medical documentation.
• Notify patient and prescriber of denials or appeals and coordinate next steps.
• Confirm plan eligibility and process test claims and day-supply calculations.
• Prioritize tasks and respond promptly to updates and inquiries.
• Maintain quality standards and reliable follow-through on tasks.

Conoscenze

Team player

Customer service

Communication

Confidentiality

Multitask

Attention to detail

Organizational skills

Formazione

HS diploma or GED

Strumenti

MS Office

Descrizione del lavoro

The Pharmacy Prior Authorization Senior Representative is responsible for obtaining initial prior authorization and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services. Collaborates with clinicians regarding supporting medical documentation in accordance with formulary guidelines. Manages the quality review of requested prior authorizations.

Responsibilities

• Obtains initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance companies via portal, phone, fax.
• Ensures initial and renewal authorizations are followed up on in a timely manner.
• Interface with other departments and identify medical documentation in support of prior authorization requests.
• Notifies the patient, prescriber and internal teams of insurance denial/appeals process.
• Confirms plan eligibility and processes test claims.
• Calculates required units and quantity vs day supply.
• Prioritizes and completes assigned tasks on schedule.
• Responds to chat/email update requests timely.
• Utilizes appropriate communication lines in relaying problems, concerns, questions, and ideas.
• Demonstrates the ability to work effectively and maintain expected productivity.
• Meets quality standards, shows pride in performance, and demonstrates reliability and follow-through on all assigned tasks.
• Demonstrates ability to communicate effectively and express ideas clearly.
• Performs in accordance with system-wide competencies/behaviors.
• Performs other duties as assigned.

Skills & Abilities

• Team player.
• Gives high priority to client satisfaction and customer needs. Maintains confidentiality of patient information.
• Provides customer service to all internal and external customers.
• Good verbal and written communication skills.
• Computer literate, with the ability to utilize standard software applications including Windows and MS
• Office Suite (Outlook, Word, and Excel).
• Good organizational skills with attention to detail and ability to multitask.

Requirements

• HS diploma or GED required.
• 2+ years of prior authorization, insurance verification or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required.
• Knowledge of medical terminology required.
• Knowledge of payer websites, eligibility, and coordination of benefits required.
• Knowledge of plan formularies and authorization requirements required.
• Knowledge of pharmacy vs medical payers and authorization required.
• Proficient computer skills and Microsoft Office Products required.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.