Pharmacy Prior Authorization Senior Representative - Freedom Fertility - Remote AZ or IL or MA

Freedom Fertility | VFP Pharmacy Group by Evernorth; Boston (MA); Hybrid; USD 26,000 - 40,000; Full time

Job summary

Freedom Fertility | VFP Pharmacy Group by Evernorth is seeking a Pharmacy Prior Authorization Senior Representative to support high-touch programs, research benefits, and process orders. You will work with patients, providers, and internal teams, ensuring accurate prescriptions and timely authorizations.

The role requires pharmacy technician experience, certification, and familiarity with EMR systems and prior authorization tools.

Qualifications

• High school diploma or GED is required.
• 2+ years of pharmacy technician experience and active certification.
• Proficient with prior authorization submission tools and EMR usage.
• Strong math, data entry and communication skills.

Responsibilities

• Enter prescriptions and adjudicate claims accurately.
• Submit prior authorizations using clinic EMR and tools.
• Follow up on benefits checks and denials with payers.
• Communicate clearly with patients, providers and internal teams.
• Handle multiple tasks while maintaining attention to detail.
• Participate in special projects and contract-specific duties.

Skills

Pharmacy experience

Prior authorization

Communication skills

Data entry

Education

High School Diploma or GED

Tools

CoverMyMeds

EMR systems

Microsoft Office

Job description

As a Pharmacy Prior Authorization Senior Representative, you will be working on a specialized team focused on high touch programs to assist our patients. This role is very detail oriented, and you'll spend most of your day researching benefits, obtaining prior authorizations, processing orders and talking to the internal sales team, patients and/or providers. Our representatives are dedicated team members who excel at customer service, helping us elevate our pharmacy patient care to new heights.

Role

• Accurately enter prescriptions into our system, adjudicate claims and work rejections. Use the knowledge you gain from training, your problem-solving skills and support from your team to accurately process prescription claims so they will be dispensed accurately.
• Accurately use the clinic specific EMR to gain additional information needed to submit prior authorizations.
• Adhere to principles as stipulated by program specific contractual agreements and company practices.
• Rapid and thorough investigation of processing/benefit inquiries from Fertility Inside Sales team
• Insurance Inquiries/benefit checks.
• Prior Authorization submission, follow up and appeals as needed.
• Juggle multiple tasks without sacrificing attention to detail.
• Help patients and providers understand their pharmacy benefits better and answer questions effectively.
• Use your strong communication skills to handle internal and external inquiries regarding prior authorizations.
• Participates in program specific customer meetings and training sessions.
• Participate in special projects and perform other duties as it pertains to specific contract performance

What You Need To Do The Job

• High School Diploma, or GED required.
• 2+ years of Pharmacy Technician experience.
• Valid National Pharmacy Technician certification is required.
• Valid Arizona, Massachusetts or Illinois State pharmacy technician license is required.
• Microsoft Office proficiency and data entry skills.
• Strong math skills related to prescription calculations.
• Exceptional attention to detail, accuracy, and quality.
• Excellent verbal and written communication skills.
• Ability to multitask in both PC/Phone related tasks.
• 1+ year relevant experience with prior authorization submission using CoverMyMeds or other like electronic prior authorization tools
• Experience with prior authorization appeals and denials
• Experience working with clinical EMR systems and/or Infertility is a plus, but not required
• Works effectively and fosters teamwork; Demonstrates ownership of projects and carries responsibility for building strong working relationships with colleagues and customers.
• Results oriented; demonstrated ability to prioritize and manage workload and meet deadlines.

Ability to work schedule depending on location and business need:

• A training shift, from 8:30 AM -5:00 PM EST, Monday-Friday
• A scheduled 8-hour shift, from 12:30 PM -9:00 PMEST, Monday-Friday
• Weekends as needed.

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.

For this position, we anticipate offering an hourly rate of 19 - 29 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 [e-mail] 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.