Authorization Representative II – BioPlus Specialty Pharmacy

Elevance Health

Authorization Representative managing pharmacy prior authorizations at Elevance Health. Ensuring accurate and complete documentation for client medications and collaborating with healthcare professionals to expedite approvals.

Posted 5/27/2026full-timeSt. Louis • Florida, Montana, Ohio • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Reviews accuracy and completeness of prior authorization information requested
ensures supporting documents are present and meet company set standards
Assists with the completion of medical necessity documentation to expedite approvals
ensures that appropriate follow up is performed
Collaborates with other departments to assist in obtaining prior authorizations/appeals
Document insurance company interactions and all prior authorization information in the system
Reviews insurance denials and submits appeals as permitted by payor
Contacts physician offices as needed to obtain demographic information or medical data

Requirements

What you’ll need

Requires a HS diploma or GED
a minimum of 2 years of experience processing pharmacy prior authorizations
a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines
Certified Pharmacy Technician highly desired
Specialty pharmacy experience highly preferred
Medical terminology training is preferred
Experience with Prior Authorizations, Denials and Appeals highly desired
Associates in this role are expected to have strong oral, written and interpersonal communication skills
problem-solving skills
facilitation skills
analytical skills

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical
dental
vision
short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
wellness programs
financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

prior authorization processingmedical necessity documentationinsurance denial reviewappeals submissiondemographic information collectionmedical data acquisitionpharmacy reimbursement guidelinesmedical terminology

Soft Skills

oral communicationwritten communicationinterpersonal communicationproblem-solvingfacilitationanalytical

Certifications

Certified Pharmacy Technician