Authorization Representative II
Core
Administer prior authorization requests for patients requiring drug approvals under various health plans, ensuring documentation accuracy and completeness.
Role type
Authorization Representative II (Specialty Pharmacy)
Builds
Prior authorization approvals and appeals for specialty medications
Domain
Healthcare / Specialty Pharmacy / Insurance Administration
Deliverable
client delivery
Required skills
Processing pharmacy prior authorizations, Medicare/Medicaid/Managed Care reimbursement guidelines, medical necessity documentation, insurance denial review, physician office communication
Preferred skills
Specialty pharmacy experience, Medical terminology training, Oncology experience
Responsibilities
Review accuracy and completeness of prior authorization information, assist with medical necessity documentation, collaborate with departments for approvals/appeals, document insurance interactions, review denials and submit appeals, contact physician offices for data