Specialty Pharmacy Prior Authorization Specialist - Hybrid

Elevance Health; Florida; Hybrid; USD 48,000 - 64,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Disability benefits

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

BioPlus Specialty Pharmacy, part of Elevance Health, seeks a Pharmacy Prior Authorization Specialist to administer prior authorizations for patients whose plans require authorization. The role supports collaboration across departments to obtain approvals and ensure accurate documentation, with an in-office 1-2 days per week hybrid schedule.

The candidate will review information for completeness, assist with medical necessity documentation, and handle communications with physicians and payers to

Qualifications

• Requires a HS diploma or GED with 2+ years in pharmacy prior authorizations.
• Experience with Medicare/Medicaid and Managed Care reimbursement guidelines preferred.
• Understanding of oncology regimens and payer criteria is beneficial.

Responsibilities

• Administer and manage prior authorization requests.
• Assist with documentation of medical necessity to expedite approvals.
• Collaborate with other departments to obtain authorizations/appeals.
• Document insurance interactions and prior authorization data in the system.
• Review insurance denials and submit appeals when permitted.
• Contact physician offices to obtain demographics or medical data.

Skills

Medical terminology training

Prior Authorization experience

Specialty pharmacy experience

Narrow payer criteria interpretation

Education

HS diploma or GED

Job description

BioPlus Specialty Pharmacy, part of Elevance Health, seeks a Pharmacy Prior Authorization Specialist to administer prior authorizations for patients whose plans require authorization. The role supports collaboration across departments to obtain approvals and ensure accurate documentation, with an in-office 1-2 days per week hybrid schedule.

The candidate will review information for completeness, assist with medical necessity documentation, and handle communications with physicians and payers to