8 часов назад
Authorization Representative II - BioPlus Specialty Pharmacy
Вакансия из Hirify Global, списка международных tech-компанийДля мэтча и отклика нужен Plus
Мэтч & Сопровод
Для мэтча с этой вакансией нужен Plus
Описание вакансии
Текст:
TL;DR
Authorization Representative II - BioPlus Specialty Pharmacy (Prior Authorization): Processing pharmacy prior authorization requests, supporting medical necessity documentation, and coordinating approvals and appeals with payors and physician offices with an accent on specialty pharmacy operations, reimbursement guidelines, and clinical documentation. Focus on interpreting oncology regimens, anticipating payer criteria such as step therapy and site-of-care requirements, and determining effective authorization strategies.
Location: Lake Mary, Florida, United States; hybrid schedule with in-office work 1–2 days per week. Candidates must live within a reasonable commuting distance from an office unless an accommodation is granted.
Company
is a Fortune 25 healthcare company focused on improving lives and simplifying healthcare, with BioPlus Specialty Pharmacy providing specialty medication access and personalized support.
What you will do
- Review pharmacy prior authorization requests for accuracy, completeness, and required supporting documentation.
- Assist with medical necessity documentation and follow up to expedite approvals.
- Collaborate with internal departments to obtain prior authorizations and process appeals.
- Document insurance company interactions and authorization details in the relevant systems.
- Review denials and submit appeals when permitted by the payor.
- Contact physician offices to obtain demographic information and medical data.
Requirements
- High school diploma or GED.
- At least 2 years of experience processing pharmacy prior authorizations.
- At least 1 year of experience applying Medicare, Medicaid, and managed care reimbursement guidelines, or an equivalent combination of education and experience.
- Ability to interpret clinical documentation and apply critical thinking to authorization decisions.
Nice to have
- Specialty pharmacy experience.
- Medical terminology training.
- Experience with prior authorizations.
- Experience interpreting oncology regimens and payer criteria, including step therapy, site-of-care requirements, and NCCN-guided rationale.
Culture & Benefits
- Hybrid workforce strategy combining office collaboration with virtual work flexibility.
- Paid holidays, paid time off, merit increases, and incentive bonus programs.
- Medical, dental, vision, disability, life insurance, and wellness benefits.
- 401(k) with company match, stock purchase plan, and financial education resources.
- COVID-19 and influenza vaccination may be required for certain patient- or member-facing roles.
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