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Authorization Representative II - TX

  • Job Family: CUS > Care Support
  • Type: Full time
  • Date Posted:
  • Anticipated End Date:
  • Reference: JR108973

Location:

  • TX, PLANO

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Description

Authorization Representative II - Texas


Location: Hybrid, working two days a week virtually And three days a week in the office located at 4709 W Parker Rd., Plano, TX.

Work Shift Hours: Monday through Friday, 9 am to 6 pm (CST).


The Authorization Representative II is responsible for the administration of prior authorizations requests for patients whose health plan requires drug prior authorizations for different therapy types

How you will make an impact:

  • Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards.  

  • Assists with the completion of medical necessity documentation to expedite approvals and 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 system.  

  • Reviews insurance denials and submit appeals as permitted by payor.  

  • Contacts physician offices as needed to obtain demographic information or medical data.

Minimum Requirements:

  • Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations, and a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines ; or any combination of education and experience which would provide an equivalent background. 

Preferred Skills, Capabilities and Experiences:

  • Candidates who have worked for previous infusion providers/DME providers is a plus.

  • Insurance verification experience.

  • Prior authorization processing.

  • Knowledge of PPO, HMO, EPO, diagnostic codes, CPT codes, and Medicare/Medicare part D plans.

  • Experience with meeting deadlines. 


 

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

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