Pharmacy Prior Authorization Representative - Evernorth - Remote

About the position Responsibilities • Collection of structured clinical data for prior authorization and non-formulary exception requests following the guidance provided in our online prior authorization tools and corresponding forms. • Initial screening of requests based on guidance given by online prior authorization tools. • Approves prior authorization requests if the data collected meets the approval specifications. • Refers prior authorization requests that do not meet the approval specifications to a clinician for review. • Independently responds to contacts ranging from routine to moderate complexity. May seek assistance with health care professionals for service issues of substantial complexity. • Performs research to respond to inquiries and interprets policy provisions to determine the most effective response using established departmental procedures, HIPAA regulations, and corporate policies. Requirements • High School Diploma / GED • 1+ years of call center experience • Prior work from home experience • Prior medical or pharmacy knowledge • Reliable high-speed broadband internet, hard-wired connection. 10 Mbps for download / 5 MBPS for upload • Quiet and private space designated for work without interruption. • Excellent Customer Service • Excellent interpersonal communication, attention to detail, and critical thinking skills are essential. • Excellent computer skills, with familiarity of Microsoft office and have a working knowledge of Windows operating system. • Tech savvy, with the ability to easily navigate across multiple screens and applications. • Must work any schedule between 8:00am – 9:00pm EST. Nice-to-haves • Flexibility to support extended hours and overtime as determined by business needs to meet customer expectations. Benefits • Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs. • 401(k) with company match • Company paid life insurance • Tuition reimbursement • A minimum of 18 days of paid time off per year • Paid holidays • Annual bonus plan eligibility. Apply tot his job Apply To this Job