Pharmacy Prior Authorization Senior Representative - Freedom Fertility - RemoteAZ or IL or MA

Cigna Healthcare; New York (NY); Remoto; USD 26.000 - 40.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health benefits

401(k)

Tuition reimbursement

Paid time off

Paid holidays

Life insurance

Descrizione del lavoro

The Cigna Group is seeking a Pharmacy Prior Authorization Senior Representative to join a dedicated team handling high-touch programs. You will research benefits, process prior authorizations, and communicate with patients, providers, and internal teams with precision.

You will work with EMR systems and CoverMyMeds for prior authorizations, appeals, and denials, ensuring accurate claims processing and excellent service across clinics.

Competenze

• High School Diploma or GED required.
• 2+ years of Pharmacy Technician experience.
• Valid National Pharmacy Technician certification is required.
• Valid AZ, MA or IL Pharmacist Technician license required.
• Proficient in Microsoft Office and data entry.
• Strong math skills for prescription calculations.
• Exceptional attention to detail and accuracy.
• Excellent verbal and written communication skills.
• Ability to multitask between PC and phone tasks.
• Experience with prior authorization submission using CoverMyMeds or similar tools.
• Experience with prior authorization appeals/denials.

Mansioni

• Enter prescriptions accurately and adjudicate claims.
• Use EMR to obtain information for prior authorizations.
• Submit prior authorizations and follow up as needed.
• Handle inquiries from Sales, patients and providers.
• Investigate processing/benefit inquiries quickly and thoroughly.
• Communicate benefits clearly to patients and providers.
• Participate in program meetings and trainings.
• Support special projects related to contracts.

Conoscenze

Pharmacy Tech Experience

National Certification

State Licenses AZ MA IL

Microsoft Office

Data Entry

Math Skills

Attention to Detail

Verbal & Written Communication

Multitasking

Prior Authorization Tools

Appeals & Denials

EMR Systems

Infertility Experience (plus)

Formazione

High School Diploma or GED

Strumenti

CoverMyMeds

EMR Systems

Descrizione del lavoro

Pharmacy Prior Authorization Senior Representative

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.

In this role, you will be part of a specialized team, working with a specific group of clinics, to complete the prior authorization process using both internal and external pharmacy and clinic systems.

• 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 similar 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 PM EST, 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.

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.

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 in a manner consistent with all federal, state and local ordinances.