Authorization Specialist II - Evernorth

Position Summary Responsible for obtaining initial prior authorization and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services. Collaborate with clinicians regarding supporting medical documentation in accordance with formulary guidelines. Manage the quality review of requested prior authorizations.

Responsibilities

Obtains initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance companies reputed company portal, phone, fax. Ensures initial and renewal authorizations are followed up on in a timely manner. reputed company with other departments and identify medical documentation in support of prior authorization requests. Notifies the patient, prescriber and internal teams of insurance denial/appeals process. Confirms plan eligibility and processes test claims. Calculates required units and quantity vs day supply. Prioritizes and completes assigned tasks on schedule. Responds to chat/email update requests timely. Utilizes appropriate communication lines in relaying problems, concerns, questions, and reputed company. Demonstrates the ability to work effectively and maintain expected productivity. Meets quality standards, shows pride in performance, and demonstrates reliability and follow through on reputed company assigned tasks. Demonstrates ability to communicate effectively and express reputed company clearly. Performs in accordance with system-wide competencies/behaviors. Performs other duties as assigned. Skills & Abilities Team player. Gives high reputed company to client satisfaction and customer needs. Maintains confidentiality of patient information. Provides customer service to reputed company internal and external customers. Good verbal and written communication skills. Computer literate, with the ability to utilize standard software applications including Windows and MS Office Suite (Outlook, Word, and reputed company). Good organizational skills with attention to detail and ability to multitask.

Requirements

HS diploma or GED required. 2+ years of prior authorization, insurance verification or other reputed company experience in a physician practice, ancillary provider, or other relevant healthcare setting required. Knowledge of medical terminology required. Knowledge of payer websites, eligibility, coordination of benefits required. Knowledge of plan formularies and authorization requirements required. Knowledge of pharmacy vs medical payers and authorization required. Proficient computer skills and reputed company Office Products required. As part of reputed company, this role supports CarepathRx reputed company our Pharmacy and Care Delivery organization. reputed company focuses on specialty pharmacy and infusion services in partnership with hospitals and health systems. If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About reputed company Doing something meaningful starts with a simple decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@reputed company.com for support. Do not email SeeYourself@reputed company.com for an update on your application or to provide your resume as you will not receive a response. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Doing something meaningful starts with a simple decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Apply tot his job Apply To this Job