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Prior Authorization Representative Express Scripts Jobs in Florida

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 ...

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 ...

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 ...

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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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:
What job categories do people searching Prior Authorization Representative Express Scripts jobs in Florida look for? The top searched job categories for Prior Authorization Representative Express Scripts jobs in Florida are:
Authorization Representative

Authorization Representative

Florida Orthopaedic Institute

Saint Petersburg, FL • On-site

$16 - $20.50/hr

Other

Posted 5 days ago


Key responsibilities

  • Coordinate with primary care physicians and insurance companies to obtain referrals and authorizations for office visits.

  • Ensure all authorizations are accurately documented in the system.

  • Advise patients of any potential problems regarding obtaining authorization prior to their scheduled appointments.


Florida Orthopaedic Institute rating

8.7

Company rating: 8.7 out of 10

Based on 6 frontline employees who took The Breakroom Quiz


Job description

Position Summary: Responsible for accurately and efficiently obtaining and documenting all referrals and authorizations. Ensures all patients are authorized for the physician, the date of service and all anticipated services. Referrals and Authorizations are obtained by contacting physician's offices, insurance companies, and/or the patient.
Key Responsibilities:
  • Coordinate with appropriate primary care physicians and/or insurance companies to obtain referrals for office visits prior to the patient's scheduled appointment.
  • Ensure all authorizations are properly documented in the system.
  • Advise patients of any potential problems concerning obtaining authorization prior to the scheduled appointment.
  • Coordinate with the Billing/Collections department to research and obtain authorizations on previously denied claims.
  • Coordinate with the Benefit Verification Rep to confirm benefits when problems occur.
  • Utilize insurance websites (Availity, Humana Military (Tricare),United Healthcare, etc.) to obtain referrals/authorizations
  • All other duties as assigned
Qualifications:
  • Candidate must be a high school graduate.
  • 2 or more years of experience in a medical environment.
  • Excellent customer service and communication skills.
  • Able to multi-task and handle high call volumes.
  • Excellent Data entry Skills

Orthopaedic Solutions Management is a Drug Free Workplace
We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.
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.