Senior Pharmacy Prior Authorization Representative

🔥 16 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟠 Senior

💊 Pharmacist

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Obtain initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance companies via portal, phone, and fax • Follow up on initial and renewal authorizations in a timely manner • Collaborate with clinicians and other departments to identify supporting medical documentation • Notify patients, prescribers, and internal teams of insurance denials and appeals processes • Confirm plan eligibility and process test claims • Calculate required units and quantity versus day supply • Prioritize and complete assigned tasks on schedule • Respond to chat and email update requests promptly • Communicate problems, concerns, questions, and ideas through appropriate channels • Maintain expected productivity and quality standards • Perform other assigned duties

🎯 Requirements

• HS diploma or GED required • 2+ years of prior authorization, insurance verification or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required • Knowledge of medical terminology required • Knowledge of payer websites, eligibility, and 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 Microsoft Office Products required • Computer literacy, including Windows and MS Office Suite (Outlook, Word, and Excel) • Good organizational skills with attention to detail and ability to multitask • Good verbal and written communication skills • Ability to maintain confidentiality of patient information • Internet connection through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload when working from home

🏖️ Benefits

• Remote work option (occasionally or permanently) • Cable broadband or fiber optic internet requirement for home working, with at least 10Mbps download/5Mbps upload • Tobacco-free policy • Reasonable accommodation support for the online application process