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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 ...

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 ...

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 ...

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Prior Authorization Representative Express Scripts information

What is a Prior Authorization Representative Express Scripts job?

A Prior Authorization Representative at Express Scripts is responsible for reviewing and processing medication prior authorization requests from healthcare providers and pharmacies. They assess requests based on insurance coverage policies, ensuring prescriptions meet clinical and formulary guidelines. The representative communicates approval or denial decisions and may collaborate with prescribers for additional information. Strong attention to detail, customer service skills, and knowledge of medical terminology are essential for success in this role.

What are the typical daily responsibilities of a Prior Authorization Representative at Express Scripts?

In this role, you will review and process prior authorization requests for prescription medications, ensuring that all necessary documentation and criteria are met. You’ll communicate frequently with healthcare providers, patients, and insurance companies to gather information, explain coverage decisions, and resolve any issues. Coordination with pharmacy teams and use of specialized software are also routine responsibilities. The position requires strong organizational skills and adaptability, as you will often manage multiple cases with varying priorities throughout your day.

What are the key skills and qualifications needed to thrive in the Prior Authorization Representative Express Scripts position, and why are they important?

To excel as a Prior Authorization Representative at Express Scripts, you need strong knowledge of pharmacy benefits, medical terminology, and insurance processes, often supported by experience in healthcare or pharmacy settings. Familiarity with prior authorization systems, insurance verification tools, and HIPAA compliance is important, and some employers may prefer a pharmacy technician certification. Exceptional communication, attention to detail, and problem-solving skills help representatives navigate patient and provider inquiries efficiently. These qualifications ensure timely and accurate processing of medication requests, helping patients access care while maintaining regulatory and company standards.

What are the most commonly searched types of Prior Authorization Representative Express Scripts jobs in Florida? The most popular types of Prior Authorization Representative Express Scripts jobs in Florida are:
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Prior Authorization Representative Express Scripts jobs near you
Infographic showing various Prior Authorization Representative Express Scripts job openings in Florida as of July 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Prior Authorization Specialist

Cinq Group

Altamonte Springs, FL

$16.75 - $22.50/hr

Full-time

Posted 26 days 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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