Express Scripts Prior Authorization Jobs in Florida

Position Summary
The Single Case Agreement (SCA) Specialist is responsible for securing reimbursement and coverage for services, therapies, or medical technologies on a patient-by-patient basis through negotiation with health plans. This role serves as a key liaison between providers, payers, patients, and internal teams to ensure timely access to care when standard coverage pathways are not available.
About RomTech
ROMTech® is a groundbreaking telemedicine technology with remote clinical oversight and fully customizable therapy protocols. The PortableConnect® (the device) enables gentle, therapeutic movement within a comfortable range of motion. Light, easy, and frequent sessions make it easier for the body to heal and recover. The result: patients recover and return to their activities of daily living more quickly, with less pain and drugs, and with better mobility.
Key Responsibilities
o Initiate and lead negotiations with commercial and government health plans to establish Single Case Agreements (SCAs)
o Secure appropriate reimbursement rates, terms, and coverage conditions for out-of-network or non-contracted services
o Communicate clinical and economic value propositions to payer medical directors and contracting teams
o Manage a pipeline of patient-specific cases from intake through agreement execution and reimbursement
o Coordinate with clinical, reimbursement, and intake teams to gather necessary documentation (e.g., medical necessity, prior authorizations)
o Track case progress, timelines, and outcomes to ensure timely patient access
• Documentation & Compliance
o Draft, review, and finalize SCA contracts in collaboration with legal and compliance teams
o Ensure all agreements adhere to payer requirements, regulatory standards, and internal policies
o Maintain accurate records of negotiations, approvals, and contract terms
• Cross-Functional Collaboration
o Partner with providers, revenue cycle teams, and patient access teams to align strategy and communication
o Educate internal stakeholders on payer requirements, negotiation strategies, and SCA processes
o Serve as a subject matter expert on reimbursement pathways for non-covered or out-of-network services
Qualifications
• 3-7+ years of experience in healthcare reimbursement, payer relations, managed care contracting, or revenue cycle
• Proven experience negotiating with health plans (SCAs, LOAs, or out-of-network agreements preferred)
• Strong understanding of prior authorization, medical necessity, and appeals processes
• Knowledge of commercial insurance, Medicare, and Medicaid structures
Key Skills
• Strong negotiation and influencing skills
• Ability to communicate clinical and financial value effectively
• Detail-oriented with strong organizational and case management abilities
• Comfortable working in fast-paced, high-stakes patient access environments
• Excellent written and verbal communication skills
Preferred Experience
• Experience working with specialty therapies, medical devices, or high-cost procedures
• Familiarity with CPT/HCPCS coding and reimbursement methodologies
• Prior interaction with payer medical directors or utilization management team
Physical Demands and Working Conditions
The following describes the physical demands and work environment characteristics required to perform the essential functions of this position. These requirements are representative of those an employee may encounter while performing the job and are not intended to be an exhaustive list. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.

• Ability to sit at a computer terminal for an extended period.
• Moderate noise (i.e., phone calls, online meetings, computer audio)
• While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard.
• Specific vision abilities required by this job include close vision requirements due to computer work.
• Regular, predictable attendance is required.
• Must be able to communicate clearly and professionally in both verbal and written formats.
• Must be able to engage in active listening and express ideas effectively in person, by phone, and via virtual meetings.