Senior Pharmacy Prior Authorization Specialist II

Elevance Health, Inc.; Harvey (LA); Hybrid; USD 55,000 - 70,000; Full time

Job summary

BioPlus Specialty Pharmacy is seeking a Pharmacy Prior Authorization Specialist to manage PA requests for patients under various health plans. The role supports a hybrid work model with 1–2 days in-office and occasional alternate locations for those within commuting distance.

The specialist will review documentation, assist with medical necessity, and coordinate with physicians and payors to obtain timely approvals and appeals. Experience with Medicare/Medicaid guidelines is preferred.

Qualifications

• HS diploma or GED with 2+ years of pharmacy prior authorization experience.
• At least 1 year knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines.
• Experience interpreting clinical documentation and payer criteria.

Responsibilities

• 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 PA information in the system.
• Review denials and submit appeals as permitted by payor.
• Contact physician offices to obtain demographic or medical data.

Skills

Specialty pharmacy experience

Medical terminology

Prior Authorization experience

Critical thinking

Education

HS diploma or GED

Job description

BioPlus Specialty Pharmacy is seeking a Pharmacy Prior Authorization Specialist to manage PA requests for patients under various health plans. The role supports a hybrid work model with 1–2 days in-office and occasional alternate locations for those within commuting distance.

The specialist will review documentation, assist with medical necessity, and coordinate with physicians and payors to obtain timely approvals and appeals. Experience with Medicare/Medicaid guidelines is preferred.