Senior Pharmacy Prior Authorization Representative

🔥 13 hours ago

🌵 Arizona, Illinois, +1 more states – Remote

🌵 Arizona – Remote 🌽 Illinois – Remote 🍂 Massachusetts – Remote

💵 $19 - $29 / hour

⏰ Full Time

🟠 Senior

💊 Pharmacist

👻 Ghost score 0%

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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

• Enter prescriptions accurately into the system, adjudicate claims, and work rejections • Use clinic-specific EMR systems to gather information for prior authorizations • Adhere to program-specific contractual agreements and company practices • Investigate processing and benefit inquiries from the Fertility Inside Sales team • Conduct insurance inquiries and benefit checks • Submit, follow up on, and appeal prior authorizations as needed • Help patients and providers understand pharmacy benefits and answer questions • Handle internal and external prior authorization inquiries • Participate in program-specific customer meetings and training sessions • Participate in special projects and perform other duties related to contract performance • Work with a specialized team supporting specific groups of clinics and high-touch patient programs

🎯 Requirements

• High School Diploma or GED required • 2+ years of Pharmacy Technician experience • Valid National Pharmacy Technician certification required • Valid Arizona, Massachusetts, or Illinois State pharmacy technician license required • Microsoft Office proficiency and data entry skills • Strong math skills related to prescription calculations • Exceptional attention to detail, accuracy, and quality • Excellent verbal and written communication skills • Ability to multitask in both PC/Phone related tasks • 1+ year relevant experience with prior authorization submission using CoverMyMeds or similar electronic prior authorization tools • Experience with prior authorization appeals and denials • Experience working with clinical EMR systems and/or infertility is a plus, but not required • Ability to prioritize and manage workload and meet deadlines • If working at home, cable broadband or fiber optic internet service with at least 10 Mbps download/5 Mbps upload • Ability to work the specified weekday shifts and weekends as needed

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence

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