Prior Authorization Specialist II — Hybrid Pharmacy

The Elevance Health Companies, Inc.; Florida; Hybrid; USD 23,000 - 41,000; Full time

Benefits offered by this job

Hybrid work schedule

Benefits package

Job summary

Elevance Health is seeking an Authorization Representative II to manage prior authorization requests for patients under various health plans. The role emphasizes accuracy, documentation, and cross‑department collaboration to expedite approvals.

The position requires a high school diploma or GED and at least 2 years in pharmacy prior authorizations plus 1 year with Medicare/Medicaid guidelines. Hybrid in-office work is required 1–2 days per week.

Qualifications

• Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations, and a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines.

Responsibilities

• Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards.
• Assists with the completion of medical necessity documentation to expedite approvals and ensures that appropriate follow up is performed.
• Collaborates with other departments to assist in obtaining prior authorizations/appeals.
• Document insurance company interactions and all prior authorization information in system.
• Reviews insurance denials and submit appeals as permitted by payor.
• Contacts physician offices as needed to obtain demographic information or medical data.

Skills

Prior authorization processing

Medical terminology

Detail oriented

Communication

Education

High School Diploma or GED

Job description

Elevance Health is seeking an Authorization Representative II to manage prior authorization requests for patients under various health plans. The role emphasizes accuracy, documentation, and cross‑department collaboration to expedite approvals.

The position requires a high school diploma or GED and at least 2 years in pharmacy prior authorizations plus 1 year with Medicare/Medicaid guidelines. Hybrid in-office work is required 1–2 days per week.