Prior Authorization Specialist II — Hybrid Pharmacy

Elevance Health; St. Louis (MO); Hybrid; USD 23,000 - 41,000; Full time

Benefits offered by this job

Comprehensive benefits

401(k) match

Equity stock purchase plan

Job summary

Elevance Health is seeking an Authorization Representative II for BioPlus Specialty Pharmacy. The role focuses on administering prior authorization requests for patients whose health plans require approvals across various therapy types.

The position is hybrid, requiring 1–2 days in-office per week, with a salary range of $16.99–$29.52 per hour and comprehensive benefits. Location options include the St. Louis office, with a broader Elevance Health regional footprint.

Qualifications

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

Responsibilities

• Review accuracy and completeness of prior authorization information and ensure documents meet standards.
• Assist with medical necessity documentation to expedite approvals and ensure proper follow-up.
• Collaborate with other departments to obtain prior authorizations or appeals.
• Document insurance interactions and all prior authorization data in the system.
• Review insurance denials and submit appeals as permitted by payor.
• Contact physician offices to obtain demographic or medical information.

Skills

Pharmacy prior authorizations

Medicare/Medicaid guidelines

Medical terminology

Education

HS diploma or GED

Job description

Elevance Health is seeking an Authorization Representative II for BioPlus Specialty Pharmacy. The role focuses on administering prior authorization requests for patients whose health plans require approvals across various therapy types.

The position is hybrid, requiring 1–2 days in-office per week, with a salary range of $16.99–$29.52 per hour and comprehensive benefits. Location options include the St. Louis office, with a broader Elevance Health regional footprint.