Authorization Representative II – BioPlus Specialty Pharmacy

Elevance Health

. Administer prior authorization requests for patients whose health plans require drug prior authorizations .

Posted 9/15/2026full-timeLake Mary • Colorado • United StatesJuniorMid-Level💰 $18 - $30 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in processing pharmacy prior authorizations, applying Medicare, Medicaid, and Managed Care reimbursement guidelines, and collaborating effectively with healthcare professionals to ensure timely approvals. Proficient in medical terminology and experienced in specialty pharmacy and oncology settings.

Highest-signal resume keywords

Pharmacy Prior Authorization ProcessingMedicare Reimbursement GuidelinesMedicaid Reimbursement GuidelinesManaged Care Reimbursement GuidelinesMedical Terminology

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Prior Authorization AdministrationMedical Necessity DocumentationInsurance Denial ReviewAppeal SubmissionDemographic Data Collection

Soft Skills

CollaborationAttention to DetailFollow-Up

Tools & Technologies

Prior Authorization System

Industry Keywords

Specialty PharmacyOncologyHealth PlansPatient InteractionCOVID-19 Vaccination Requirement

About the role

Key responsibilities & impact

Administer prior authorization requests for patients whose health plans require drug prior authorizations
Review the accuracy and completeness of prior authorization information
Ensure supporting documents are present and meet company standards
Assist with medical necessity documentation to expedite approvals
Perform appropriate follow-up
Collaborate with other departments to obtain prior authorizations and appeals
Document insurance company interactions and prior authorization information in the system
Review insurance denials and submit appeals as permitted by payors
Contact physician offices to obtain demographic information or medical data

Requirements

What you’ll need

High school diploma or GED
Minimum 2 years of experience processing pharmacy prior authorizations
Minimum 1 year of experience applying Medicare, Medicaid, and Managed Care reimbursement guidelines
Any combination of education and experience providing an equivalent background
Specialty pharmacy experience highly preferred
Medical terminology training preferred
Oncology experience preferred
Ability to work Monday–Friday, 8:00–5:00
Must reside within a reasonable commuting distance from a posting location unless an accommodation is granted
Associates required to work in-office 1–2 days per week
Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza unless an acceptable explanation is provided

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase plan
401(k) contribution and match
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical insurance
Dental insurance
Vision insurance
Short-term disability benefits
Long-term disability benefits
Life insurance
Wellness programs
Financial education resources
Flexible virtual work options within commuting distance
Accommodation support for qualified applicants
COVID-19 and Influenza vaccination support/requirements for certain roles