[Hiring] Pharmacy Prior Authorization Senior Representative @Cigna Healthcare

Role Description

As a Pharmacy Prior Authorization Senior Representative, you will be working on a specialized team focused on high touch programs to assist our patients. This role is very detail oriented, and you'll spend most of your day researching benefits, obtaining prior authorizations, processing orders and talking to the internal sales team, patients and/or providers.

In this role, you will be part of a specialized team, working with a specific group of clinics, to complete the prior authorization process using both internal and external pharmacy and clinic systems:

• Accurately enter prescriptions into our system, adjudicate claims and work rejections.
• Use the knowledge you gain from training, your problem-solving skills and support from your team to accurately process prescription claims.
• Accurately use the clinic specific EMR to gain additional information needed to submit prior authorizations.
• Adhere to principles as stipulated by program specific contractual agreements and company practices.
• Rapid and thorough investigation of processing/benefit inquiries from Fertility Inside Sales team.
• Insurance Inquiries/benefit checks.
• Prior Authorization submission, follow up and appeals as needed.
• Juggle multiple tasks without sacrificing attention to detail.
• Help patients and providers understand their pharmacy benefits better and answer questions effectively.
• Use your strong communication skills to handle internal and external inquiries regarding prior authorizations.
• Participates in program specific customer meetings and training sessions.
• Participate in special projects and perform other duties as it pertains to specific contract performance.

Qualifications

• High School Diploma, or GED required.
• 2+ years of Pharmacy Technician experience.
• Valid National Pharmacy Technician certification is required.
• Valid Arizona, Massachusetts or Illinois State pharmacy technician license is required.
• Microsoft Office proficiency and data entry skills.
• Strong math skills related to prescription calculations.
• Exceptional attention to detail, accuracy, and quality.
• Excellent verbal and written communication skills.
• Ability to multitask in both PC/Phone related tasks.
• 1+ year relevant experience with prior authorization submission using CoverMyMeds or other like electronic prior authorization tools.
• Experience with prior authorization appeals and denials.
• Experience working with clinical EMR systems and/or Infertility is a plus, but not required.
• Works effectively and fosters teamwork; Demonstrates ownership of projects and carries responsibility for building strong working relationships with colleagues and customers.
• Results oriented; demonstrated ability to prioritize and manage workload and meet deadlines.
• Ability to work schedule depending on location and business need:
• A training shift, from 8:30 AM -5:00 PM EST, Monday-Friday.
• A scheduled 8-hour shift, from 12:30 PM -9:00 PM EST, Monday-Friday.
• Weekends as needed.

Requirements

• 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.

Benefits

• Comprehensive range of benefits, with a focus on supporting your whole health.
• Health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 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.

Company Description

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.