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Prior Authorization Representative Express Scripts Jobs in Florida

Elevance Health

Authorization Representative II

Lake Mary, FL · Hybrid

$14.75 - $17.75/hr

Authorization Representative II Location: Hybrid1: This role requires associates be in the office 1 ... Reviews accuracy and completeness of prior authorization information requested and ensures ...

Elevance Health

Authorization Representative II

Lake Mary, FL · Hybrid

$14.75 - $17.75/hr

Authorization Representative II Location: Hybrid1: This role requires associates be in the office 1 ... Reviews accuracy and completeness of prior authorization information requested and ensures ...

Mission Hospital

Authorization Representative

Largo, FL · On-site

$14.50 - $19.75/hr

Prior Authorization Specialist and Authorization Representative preferred Benefits HCA Florida Heart Institute, offers a total rewards package that supports the health, life, career and retirement of ...

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 ...

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All JobsPrior Authorization Representative Express Scripts JobsPrior Authorization Representative Express Scripts Jobs in Florida

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:
What are popular job titles related to Prior Authorization Representative Express Scripts jobs in Florida? For Prior Authorization Representative Express Scripts jobs in Florida, the most frequently searched job titles are:
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Prior Authorization Representative Express Scripts jobs near you
Clinical Services/Prior Authorization Representative

Clinical Services/Prior Authorization Representative

ProCare Rx

Gainesville, FL • On-site

$19/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

Job description

Clinical Services/Prior Authorization Representative

Location: Onsite - Gainesville, GA

Schedule: Full-Time, Monday – Friday

Pay Rate: $19.00/Hour

Description

ESSENTIAL DUTIES AND RESPONSIBILITIES include but are not limited to the following:

  • Manage incoming and outgoing calls, documenting all calls in the dedicated application for call documentation.
  • Handle letters from/to pharmacies, physicians, and healthcare providers in support of the Prior Authorization (PA) department.
  • Analyze clinical PAs using the provided clinical protocols, and provide regarding PA requests based on provided documentation.
  • Clarify any questions or concerns received from clients and/or internal departments.
  • Assists with inquiries related to pre-authorizations referred by the account managers or other departments.
  • Use online databases to document recommendations, clinical decisions, and responses.
  • Deliver high-quality customer service in a fast-paced, dedicated PA program.
  • Provide support on training new employees.
  • Participate in training, conferences, orientations, and other activities related to your business unit.
  • Must have a flexible work schedule to meet changing department needs.

QUALIFICATIONS AND REQUIREMENTS:

  • Pharmacy technician certification (CPhT) required, registered preferred.
  • Prefer 2 years experience working as a pharm tech or as a physician office assistant handling phone calls and reviewing charts.
  • 1 year experience contacting other healthcare providers as part of daily job preference.
  • Excellent communication skills working in a professional environment.
  • Strong organizational skills working under time constraints in a constantly changing environment.
  • PC experience to navigate new applications, with intermediate Excel and Word skills preferred.

Physical Demands:

  • This role is primarily sedentary and requires the ability to sit for extended periods (minimum of 7 hours).

The Perks of Joining Our Team:

  • Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
  • Time to Recharge: Paid vacation and holiday pay.
  • Focus on Your Wellness: We offer a robust Employee Wellness Program.
  • Invest in Your Future: 401(k) with a company match.
  • Support System: Employee Assistance Program provides confidential support and counseling.
  • Get Rewarded for Referring Great People: Employee referral program.

Ready to start your rewarding journey with us? Apply today!

ProCare Rx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at HumanResources@procarerx.com.

ProCare Rx is an Equal Opportunity Employer.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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