Authorization Specialist II - CarepathRx - Remote

As an Authorization Specialist II, you are responsible for obtaining initial prior authorization and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services. Collaborate with clinicians regarding supporting medical documentation in accordance with formulary guidelines. Manage the quality review of requested prior authorizations.

What you'll do to make a difference:

• Obtains initial and renewal authorizations for Specialty Pharmacy and/or Specialty Infusion services from insurance companies via portal, phone, fax.

• Ensures initial and renewal authorizations are followed up on in a timely manner.

• Interface with other departments and identify medical documentation in support of prior authorization requests.

• Notifies the patient, prescriber and internal teams of insurance denial/appeals process.

• Confirms plan eligibility and processes test claims.

• Calculates required units and quantity vs day supply.

• Prioritizes and completes assigned tasks on schedule.

• Responds to chat/email update requests timely.

• Utilizes appropriate communication lines in relaying problems, concerns, questions, and ideas.

• Demonstrates the ability to work effectively and maintain expected productivity.

• Meets quality standards, shows pride in performance, and demonstrates reliability and follow-through on all assigned tasks.

• Demonstrates ability to communicate effectively and express ideas clearly.

• Performs in accordance with system-wide competencies/behaviors.

What you need to be successful:

• High school 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, 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.

• Gives high priority to client satisfaction and customer needs. Maintains confidentiality of patient information.

• Provides customer service to all internal and external customers.

• Good verbal and written communication skills.

• Computer literate, with the ability to utilize standard software applications including Windows and MS Office Suite (Outlook, Word, and Excel).

• Good organizational skills with attention to detail and ability to multitask.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 19 - 29 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.