Prior Authorization Technician Senior Rep

Cigna in; Bloomfield (CT); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company in healthcare is seeking a Pharmacy Prior Authorization Senior Representative for a remote position. This role involves assisting patients with prior authorizations, processing orders, and ensuring excellent customer service. Ideal candidates will have at least two years of pharmacy technician experience and a valid certification. Comprehensive benefits are offered, including medical coverage, 401(k) matching, and numerous paid leave days.

Benefits

Medical, dental, and vision benefits

401(k) with match

Tuition reimbursement

At least 18 days of paid time off

Annual bonus plan eligibility

Qualifications

• 2+ years of Pharmacy Technician experience required.
• Ability to multitask across PC and phone tasks.
• 1+ year experience with prior authorization submission using tools like CoverMyMeds.

Responsibilities

• Enter prescriptions, adjudicate claims, and manage rejections.
• Submit prior authorizations and handle insurance inquiries.
• Engage in training sessions and program-specific meetings.

Skills

Attention to detail

Communication

Problem-solving

Customer service

Mathematics

Education

High School Diploma or GED

National Pharmacy Technician certification

State pharmacy technician license for AZ, MA, or IL

Tools

Microsoft Office

Clinical EMR systems

Job description

Prior Authorization Technician Senior Rep (Finance)

Pharmacy Prior Authorization Senior Representative - Remote AZ - Remote IL - Remote MA

The job profile for this position is Pharmacy Prior Authorization Senior Representative, which is a Band 2 Professional Career Track Role.

Excited to grow your career?

We value our talented employees and strive to help our associates grow professionally before recruiting new talent. If you see an open position that fits your skills, we encourage you to apply!

Our people make all the difference in our success.

As a Pharmacy Prior Authorization Senior Representative, you will be part of a specialized team focused on high-touch programs to assist our patients. This role is detail-oriented, involving researching benefits, obtaining prior authorizations, processing orders, and communicating with the internal sales team, patients, and providers. Our representatives are dedicated team members who excel at customer service and help elevate our pharmacy patient care.

Your responsibilities include:

1. Accurately entering prescriptions into our system, adjudicating claims, and working rejections using your training, problem-solving skills, and team support.
2. Using clinic-specific EMR systems to gather additional information for submitting prior authorizations.
3. Adhering to contractual agreements and company practices.
4. Investigating processing and benefit inquiries thoroughly and promptly.
5. Handling insurance inquiries and benefit checks.
6. Submitting prior authorizations, following up, and managing appeals.
7. Juggling multiple tasks while maintaining attention to detail.
8. Helping patients and providers understand their pharmacy benefits and answering questions effectively.
9. Handling internal and external inquiries regarding prior authorizations using strong communication skills.
10. Participating in program-specific meetings and training sessions.
11. Engaging in special projects as needed.

Qualifications include:

1. High School Diploma or GED.
2. 2+ years of Pharmacy Technician experience.
3. Valid National Pharmacy Technician certification.
4. State pharmacy technician license for AZ, MA, or IL.
5. Proficiency in Microsoft Office and data entry.
6. Strong math skills for prescription calculations.
7. Exceptional attention to detail, accuracy, and quality.
8. Excellent verbal and written communication skills.
9. Ability to multitask across PC and phone tasks.
10. 1+ year experience with prior authorization submission using tools like CoverMyMeds.
11. Experience with appeals and denials.
12. Experience with clinical EMR systems is a plus.
13. Ability to work effectively in a team, demonstrate ownership, and build strong relationships.
14. Results-oriented with good prioritization and deadline management.

Work schedule and additional requirements:

• 8-hour shifts between 9am-8pm EST, Monday-Friday.
• Weekends as needed.
• Reliable internet connection (minimum 10Mbps download/5Mbps upload) if working remotely.

This position may be eligible for an annual bonus plan.

We offer comprehensive benefits including medical, dental, vision, well-being programs, 401(k) with match, life insurance, tuition reimbursement, at least 18 days of paid time off, and holidays. For details, visit Life at Cigna.

We are an equal opportunity employer and consider qualified applicants regardless of race, color, age, disability, sex, pregnancy, sexual orientation, gender identity, veteran status, religion, national origin, and other protected characteristics.

For reasonable accommodations during the application process, contact [e-mail].

This role may be located remotely in AZ, IL, or MA, with salary range $19-$29/hour based on experience and location. The position may also participate in an annual bonus plan.

About Evernorth Health Services:

Evernorth, a division of The Cigna Group, creates health solutions to improve vitality and healthcare accessibility. Join us to drive growth and improve lives.

Note: Cigna has a tobacco-free policy and may not hire tobacco users in certain states. Criminal history considerations are in accordance with law.