Prior Authorization Specialist II — Hybrid Pharmacy

Elevance Health; Denver (CO); Híbrido; USD 23 000 - 41 000; Tempo integral

Resumo da oferta

Elevance Health Colorado is seeking an Authorization Representative II for BioPlus Specialty Pharmacy to manage prior authorization requests for patients under various plans. The role requires in-office 1-2 days weekly with hybrid work options in a multi-location setting.

You will review documents, assist with medical necessity, coordinate with departments, and document all interactions to expedite approvals.

Qualificações

• HS diploma or GED required with 2+ years of PA processing experience.
• At least 1 year experience applying Medicare/Medicaid and Managed Care reimbursement guidelines.

Responsabilidades

• Review accuracy and completeness of prior authorization information.
• Assist with medical necessity documentation to expedite approvals.
• Collaborate with other departments to obtain prior authorizations/appeals.
• Document insurance interactions and all prior authorization data in the system.
• Review insurance denials and submit appeals as allowed.
• Contact physician offices to obtain demographics or medical data.

Conhecimentos

Pharmacy prior authorizations

Medicare/Medicaid knowledge

Formação académica

HS diploma or GED with 2+ years PA experience

Descrição da oferta de emprego

Elevance Health Colorado is seeking an Authorization Representative II for BioPlus Specialty Pharmacy to manage prior authorization requests for patients under various plans. The role requires in-office 1-2 days weekly with hybrid work options in a multi-location setting.

You will review documents, assist with medical necessity, coordinate with departments, and document all interactions to expedite approvals.