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Overnight Prior Authorization Representative Express Scripts Jobs in Florida

Cinq Group

Prior Authorization Specialist

Altamonte Springs, FL · On-site

$16.75 - $22.50/hr

Coordinates appointment of representative document with patient and physician office. * Completes status check with insurance company regarding receipt of prior authorization and appeal and approval ...

Cinq Group

Prior Authorization Specialist

Altamonte Springs, FL · On-site

$16.75 - $22.50/hr

Coordinates appointment of representative document with patient and physician office. * Completes status check with insurance company regarding receipt of prior authorization and appeal and approval ...

Prestige Staffing

Surgery Authorization Rep

Sarasota, FL · On-site

$19 - $24/hr

Surgery Authorization Representative Pay $19-24/hr, based on experience Location Sarasota, Florida ... Obtain and follow up on necessary authorizations at least 48 hours prior to scheduled services

KabaFusion

Authorization Representative

Boca Raton, FL · On-site

$16 - $20.50/hr

... authorizations, and complete start‑of‑care documentation. This position protects revenue ... prior to deliveries to ensure accuracy, active coverage and notifies internal departments and ...

SMI IMAGING LLC

Pre-Authorization Representative

Orlando, FL · On-site

$37K - $51K/yr

Obtains pre-certification and registration prior to a patient's appointment. * Gathers pertinent ... Provides ongoing communication with patient regarding authorization and scheduling process. * Has ...

SimonMed Imaging

Pre-Authorization Representative

Orlando, FL · On-site

$16 - $20.25/hr

Obtains pre-certification and registration prior to a patient's appointment. * Gathers pertinent ... Provides ongoing communication with patient regarding authorization and scheduling process. * Has ...

SMI IMAGING LLC

Pre-Authorization Representative

Orlando, FL · On-site

$37K - $51K/yr

Obtains pre-certification and registration prior to a patient's appointment. * Gathers pertinent ... Provides ongoing communication with patient regarding authorization and scheduling process. * Has ...

SimonMed Imaging

Pre-Authorization Representative

Orlando, FL · On-site

$37K - $51K/yr

Obtains pre-certification and registration prior to a patient's appointment. * Gathers pertinent ... Provides ongoing communication with patient regarding authorization and scheduling process. * Has ...

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Overnight Prior Authorization Representative Express Scripts information

What is an Overnight Prior Authorization Representative at Express Scripts?

An Overnight Prior Authorization Representative at Express Scripts is responsible for processing and evaluating prescription medication requests that require authorization from insurance providers, primarily during overnight shifts. This role involves reviewing clinical information, communicating with healthcare providers, and ensuring that medications meet insurance guidelines for approval. Representatives also provide customer service to patients, doctors, and pharmacists, helping to resolve issues and explain the prior authorization process. Working overnight means handling requests that come in outside of typical business hours, ensuring 24/7 support for patients and providers.

What are some common challenges faced by Overnight Prior Authorization Representatives at Express Scripts, and how can they be managed?

Overnight Prior Authorization Representatives at Express Scripts often face challenges such as managing high call volumes during off-peak hours, handling urgent medication requests, and working independently with limited on-site supervision. To manage these challenges, representatives should develop strong organizational skills, remain updated on the latest formulary guidelines, and leverage internal resources or escalation protocols for complex cases. Building effective communication with pharmacists, physicians, and other team members—even during overnight shifts—can also help ensure smooth case resolution and maintain high service quality.

What are the key skills and qualifications needed to thrive as an Overnight Prior Authorization Representative at Express Scripts, and why are they important?

To thrive as an Overnight Prior Authorization Representative at Express Scripts, you need a solid understanding of pharmacy benefits, medical terminology, and prior authorization processes, often supported by a high school diploma or equivalent and relevant experience in healthcare or pharmacy. Familiarity with pharmacy management software, claims processing systems, and Microsoft Office Suite is typically required. Attention to detail, strong problem-solving skills, and effective communication are critical soft skills for success in this position. These competencies ensure accurate and timely authorization decisions, safeguard patient access to medications, and uphold compliance with regulatory standards during overnight shifts.
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Overnight Prior Authorization Representative Express Scripts jobs near you

Prior Authorization Specialist

Cinq Group

Altamonte Springs, FL • On-site

$16.75 - $22.50/hr

Full-time

Posted 18 hours ago

Job description

Company Description

Here at CiNQ Recruitment, we believe in finding the right fit, for you and our clients. Whether you seek long-term employment solutions for your business or your next career move, we understand the importance of individual and business needs. With over 30 years of successful staffing and recruiting experience, we excel at providing passive candidates with the right skills and cultural fit for specialized positions. Here is the opportunity to work with an exciting pharmaceutical company.

Job Description

Hiring Manager Notes:

  • M-F 11a-8p
  • $16-$19
  • At least 1-2 years of insurance verification
  • FULL PA process- obtaining the PA form, filling it out, calling dr. office and obtaining lab and cart notes.
  • Pharmacy background a good plus
  • Eligibility verification/investigation experience
  • Well spoken

Position Summary:

Perform duties to assist patients with access to benefits and co-pay cards, and schedule delivery of prescriptions provided through the specialty pharmacy, working within the limits of standard or accepted practice.

Essential Functions:

  • Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships that yield loyalty.
  • Investigate and verify benefits for pharmacy and medical third party claims for assigned cases. May communicate with financial assistance team of drug manufacturers to apply for and secure financial assistance for patient when assigned.
  • Obtain prior authorizations; initiate requests, follow up to provide additionally required information, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed. Review for accuracy of prescribed treatment regimen prior to submission of authorization.
  • Facilitate appeals process between the patient, physician and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician. Composes clinical appeals letters based off of specific denial reason and patients clinical presentation. Ensures all clinical information and documentation are obtained prior to appeal submission. Coordinates appointment of representative document with patient and physician office.
  • Completes status check with insurance company regarding receipt of prior authorization and appeal and approval or denial status. 
Additional Information

All your information will be kept confidential according to EEO guidelines.

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