Senior Pharmacy Prior Authorization Representative

🔥 1 hour 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Research benefits and obtain prior authorizations • Process prescription orders and communicate with sales teams, patients, and providers • Enter prescriptions, adjudicate claims, and resolve claim rejections • Use clinic-specific EMR systems to obtain information for prior authorization submissions • Follow program-specific contractual agreements and company practices • Investigate processing and benefit inquiries from the Fertility Inside Sales team • Perform insurance inquiries and benefit checks • Submit, follow up on, and appeal prior authorizations as needed • Explain pharmacy benefits and answer patient and provider questions • Handle internal and external prior authorization inquiries • Participate in program-specific customer meetings and training sessions • Participate in special projects and perform duties related to contract performance

🎯 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 work the specified training and scheduled shifts, including weekends as needed • For home working, cable broadband or fiber optic internet with at least 10 Mbps download/5 Mbps upload • Ability to prioritize and manage workload, meet deadlines, and build strong working relationships

🏖️ 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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