Authorization Representative II - BioPlus Specialty Pharmacy
Core
Administer prior authorization requests and appeals for specialty medications to ensure patient access to therapy.
Role type
Authorization Representative II (Specialty Pharmacy)
Builds
Prior authorization approvals and appeals for specialty drug therapies
Domain
Healthcare / Specialty Pharmacy / Insurance Reimbursement
Deliverable
client delivery
Required skills
Processing pharmacy prior authorizations, Medicare/Medicaid/Managed Care reimbursement guidelines, Medical necessity documentation, Insurance denial review, Physician office communication, Data entry
Preferred skills
Specialty pharmacy experience, Medical terminology training, Oncology experience
Responsibilities
Review accuracy and completeness of prior authorization requests, Assist with medical necessity documentation, Collaborate with departments to obtain authorizations/appeals, Document insurance interactions, Review denials and submit appeals, Contact physician offices for data