Authorization Representative II – BioPlus Specialty Pharmacy

Elevance Health

. Review the accuracy and completeness of prior authorization information .

Posted 10/9/2026full-timeUnited StatesJuniorMid-Level💰 $17 - $30 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing pharmacy prior authorizations, applying Medicare, Medicaid, and Managed Care reimbursement guidelines, and collaborating with healthcare professionals to ensure accurate documentation and expedite approvals.

Highest-signal resume keywords

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior Authorization ReviewMedical Necessity DocumentationInsurance Denial ReviewAppeals SubmissionDemographic Information Collection

Soft Skills

CollaborationAttention to DetailFollow-Up

Certifications & Qualifications

HS DiplomaGED

Industry Keywords

Specialty PharmacyOncology Experience

About the role

Key responsibilities & impact

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 payor
Contact physician offices to obtain demographic information or medical data

Requirements

What you’ll need

HS diploma or GED
Minimum of 2 years of experience processing pharmacy prior authorizations
Minimum of 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 in-office 1–2 days per week
Must be within a reasonable commuting distance from a posting location unless an accommodation is granted
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
401(k) contribution and match
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Hybrid work flexibility
COVID-19 and Influenza vaccination accommodations as permitted by law