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- 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.
- Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations; or any combination of education and experience which would provide an equivalent background.
- A minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines.
- Specialty pharmacy experience highly preferred.
- Experience as a pharmacy tech is very helpful.
- Familiarity with multiple health plans (Optum/CareMark/Alliance RX/etc) is a must for this position.
- Medical terminology training preferred.
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Authorization Rep II - Saint Louis, United States - Elevance Health
Description
Be Part of an Extraordinary Team
BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies.
Together, CarelonRx and 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.
LOCATION:
This role requires that you work onsite at 1831 Chestnut Street, St. Louis. Candidates must reside within 50 miles/1-hour commute of this location.
HOURS:
Monday through Friday, 9:00 am - 6:00 pm or 10:00 am - 7:00 pm
Responsible for the administration of prior authorizations requests for patients whose health plan requires drug prior authorizations for different therapy types.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with 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.
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.
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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.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. 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.
