Anticipated End Date:
2026-07-17Position Title:
Authorization Representative II - BioPlus Specialty PharmacyJob Description:
Pharmacy Prior Authorization Specialist - BioPlus Specialty Pharmacy
Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.
The Pharmacy Prior Authorization Specialist will be 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.
Documents 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.
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:
Specialty pharmacy experience highly preferred.
Medical terminology training is preferred.
Prior Authorization experience is highly desired.
Use critical thinking to interpret oncology regimens and supporting clinical documentation, anticipates payer criteria (e.g., step therapy, site-of-care, NCCN-guided rationale), and determine the best authorization strategy and next step is desired.
Job Level:
Non-Management Non-ExemptWorkshift:
1st Shift (United States of America)Job Family:
CUS > Care SupportPlease 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.
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 and Influenza. 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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
Skills Required
- High school diploma or GED
- Minimum 2 years processing pharmacy prior authorizations
- Minimum 1 year applying Medicare, Medicaid and Managed Care reimbursement guidelines
- Specialty pharmacy experience
- Medical terminology training
- Prior authorization experience
- Ability to interpret oncology regimens and payer criteria (e.g., step therapy, site-of-care, NCCN-guided rationale)
Elevance Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Elevance Health and has not been reviewed or approved by Elevance Health.
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Strong & Reliable Incentives — Bonuses are often described as “awesome,” and incentive programs are positioned as a meaningful contributor to total rewards beyond base pay. Regular bonus and raise cycles are also associated with sustained earnings increases over multiple years in some roles.
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Parental & Family Support — Family-focused benefits are broad, including paid parental leave, a parental transition week, and critical caregiving leave. Adoption and surrogacy assistance and a Dependent Care FSA with employer matching further strengthen support for caregiving responsibilities.
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Retirement Support — A 401(k) plan with employer matching is part of the core package and is consistently cited as a foundational financial benefit. Stock purchase access is also included as an additional long-term savings and ownership option.
Elevance Health Insights
What We Do
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
