Authorization Representative II - BioPlus Specialty Pharmacy

Elevance Health • Saint Louis, MO • 2h ago

Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies . BioPlus offer consumers and providers an unparalleled level of service that's easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer's treatment journey.

The Authorization Representative II is responsible for the administration of prior authorizations requests for patients whose health plan requires drug prior authorizations for different therapy @types.

How you will make an impact:

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.

Minimum Requirements:

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; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

Certified Pharmacy Technician highly desired.

Specialty pharmacy experience highly preferred.

Medical terminology training is preferred.

Experience with Prior Authorizations, Denials and Appeals highly desired.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) .

Similar Jobs

Lead Physical Therapist - acute care

BJC HealthCare • Saint Louis, MO • 1h ago

Hospital & Medical

City/State: Saint Louis, Missouri Categories: Rehabilitation Services Job Status: Full-Time Req ID : 108452 Pay Range: $86,195.20 - $137,904.00 / year (Salary or hourly rate is based on job qualifications and relevant wo...

1h ago

Go to Apply

ANM - Medical Oncology

BJC HealthCare • Saint Louis, MO • 5h ago

Hospital & Medical

City/State: Saint Louis, Missouri Categories: Nursing Services Job Status: Full-Time Req ID : 108761 Pay Range: $84,240.00 - $128,419.20 / year (Salary or hourly rate is based on job qualifications and relevant work expe...

5h ago

Go to Apply

Manufacturing Technician

Aerotek • Saint Louis, MO • 14h ago

Hospital & Medical

Job Title: Manufacturing Technician (Tech I / Tech II) Job Description The Manufacturing Technician supports safe, compliant, and efficient production operations in a cGMP manufacturing environment. This role prepares an...

14h ago

Go to Apply

Counsel- Health Law

The Cigna Group • Saint Louis, MO • 19h ago

Hospital & Medical

The Counsel - PBM Sales and Account Management position provides enterprise-wide support and guidance for U.S. contracting activities, with an emphasis on pharmacy benefit management agreements between Express Scripts an...

19h ago

Go to Apply

QC Laboratory Technician

Actalent • Saint Louis, MO • 23h ago

Hospital & Medical

Job Title: QC Laboratory Support TechnicianJob Description The QC Laboratory Support Technician provides essential support to a Quality Control laboratory within an animal health pharmaceutical environment. This role foc...

23h ago

Go to Apply

Medical Assistant 22-24/HR

Actalent • Saint Louis, MO • 23h ago

Hospital & Medical

Job Title: Medical Assistant Job Description The Medical Assistant supports a single physician by providing comprehensive clinical care to a high-volume panel of adult and geriatric patients. This role includes performin...

23h ago

Go to Apply

Physical Therapist - Float

Select Medical • Collinsville, IL • 1d ago

Hospital & Medical

Overview SSM Health Physical Therapy (Outpatient) Collinsville, IL Physical Therapist (PT) -Float Salary: $75,000 - $100,000 annually, based on years of experience. This is a full time position that will be based out of...

1d ago

Go to Apply

Physical Therapist - PRN

Select Medical • Bridgeton, MO • 1d ago

Hospital & Medical

Overview SSM Health Day Institute Bridgeton, MO Physical Therapist (PT) PRN - Tier II Hours: 60+ shift hours per month Pay Rate: Tier II - $45 per hour Licensing: Must licensed in both MO and IL; we will assist with cost...

1d ago

Go to Apply

Physical Therapist

Select Medical • Brentwood, MO • 1d ago

Hospital & Medical

Overview SSM Health Physical Therapy Brentwood, MO Physical Therapist (PT) SSM Health Physical Therapy is the premier provider of comprehensive outpatient services! With a network of more than 80 outpatient physical ther...

1d ago

Go to Apply

Physical Therapist

Select Medical • Ferguson, MO • 1d ago

Hospital & Medical

Overview SSM Health Physical Therapy Florissant, MO Physical Therapist (PT) Full Time SSM Health Physical Therapy is the premier provider of comprehensive outpatient services! With a network of more than 80 outpatient ph...

1d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

Similar Jobs

Lead Physical Therapist - acute care

ANM - Medical Oncology

Manufacturing Technician

Counsel- Health Law

***QC Laboratory Technician***

**Medical Assistant** 22-24/HR

Physical Therapist - Float

Physical Therapist - PRN

Physical Therapist

Physical Therapist

QC Laboratory Technician

Medical Assistant 22-24/HR