Authorization Representative II - BioPlus Specialty Pharmacy
Core
Administer prior authorization requests for patients requiring specialty medications, ensuring medical necessity documentation meets payer criteria to expedite approvals.
Role type
Pharmacy Prior Authorization Specialist
Builds
Approvals for specialty medication therapies
Domain
Healthcare / Specialty Pharmacy
Deliverable
client delivery
Required skills
Medicare/Medicaid/Managed Care reimbursement guidelines, medical necessity documentation, insurance denial appeals, physician office communication, regulatory compliance
Preferred skills
Specialty pharmacy experience, oncology regimen interpretation, NCCN-guided rationale application, step therapy criteria analysis
Technologies
Elevance Health systems, payer portals
Responsibilities
Review accuracy and completeness of prior authorization requests, assist in completing medical necessity documentation, collaborate with departments for appeals, document insurance interactions, review denials and submit appeals, contact physician offices for data
Seniority
Individual Contributor, Non-Management