Senior Pharmacy Prior Authorization Representative

Job not on LinkedIn

🔥 8 minutes ago

🐊 Florida, North Carolina – Remote

🐊 Florida – Remote 🌲 North Carolina – 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

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

• 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 • Interface with other departments and identify medical documentation supporting prior authorization requests • 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 timely • Relay problems, concerns, questions, and ideas through appropriate communication lines • Maintain expected productivity and work effectively • Meet quality standards and demonstrate reliability and follow-through • Communicate effectively and express ideas clearly • Perform in accordance with system-wide competencies and behaviors • Perform other duties as assigned

🎯 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) • If working at home occasionally or permanently, internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Remote work arrangement • Work-from-home internet service requirement with minimum speeds of 10Mbps download/5Mbps upload • Tobacco-free policy and smoking cessation program eligibility where applicable