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Prior Authorization Representative Express Scripts Jobs in Florida

Quipt Home Medical

Customer Service Representative

Orlando, FL · On-site

$15 - $20.25/hr

Customer Service Representative Position Reports To Branch Manager/CSR Director Position Summary As ... CMN Requirements and Prior Authorizations * Documentation Requirements of the Equipment * Patient ...

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Prior Authorization Representative Express Scripts information

What is a prior authorization representative Express Scripts?

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 does a prior authorization representative Express Scripts do?

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 as a prior authorization representative Express Scripts?

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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For Prior Authorization Representative Express Scripts jobs in Florida, the most frequently searched job titles are:

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The top searched job categories for Prior Authorization Representative Express Scripts jobs in Florida are:

Prior Authorization Representative Express Scripts jobs near you
Infographic showing various Prior Authorization Representative Express Scripts job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Specialty Pharmacy Technician - Scripts Retail Pharmacy - Bayfront Hospital

Bayfront Health

Saint Petersburg, FL • On-site

$16.75 - $20.25/hr

Full-time

Posted 14 days ago

Job description

Position Summary

Ensures proper processing and problem solving of specialty prescriptions, assisting with operational and all distribution responsibilities as they are related to Specialty Technician functions.

This position is located at Bayfront Hospital, Scripts Retail Pharmacy in Saint Petersburg, FL

Responsibilities
  • Demonstrates proficiency in prescription processing: read/review prescription orders, evaluate for completeness and ensure accurate data entry of all drug and ancillary supplies.
  • Accurately assists the pharmacist in all medication distribution from picking, filling, labeling, dispensing in appropriate packaging and staying compliant with regulatory standards.
  • Demonstrates the ability to operate the equipment required for pharmacy procedures, consistent with operating instructions, safety regulations and policy and procedures.
  • Utilizes critical thinking and analytical skills in job performance and independently solves problems.
  • Ability to create and maintain providers profile in computer systems for demographics, DEA and NPI numbers.
  • Maintains patient profiles with necessary demographic, allergies, insurance both primary and secondary, payment/delivery information which is consistent with department service standards.
  • Demonstrates clear understanding of adjudication of claims and prior authorization processing procedures as pertaining to department standards.
  • Ability to work with primary and secondary payors to assure patients medication needs are met in a timely manner with most financial assistance.
  • Works with patients to evaluate eligibility in medication assistance programs, accesses appropriate reimbursement programs and enrolls patients.
  • Demonstrates the ability to identify and utilize resources and departments for customer service and patient care while triaging patient calls.
  • Ability to communicate clearly to patients about their copays and financial responsibility.
  • Maintains USP 800 and other regulatory required logs.
  • Maintains safe handling and proper disposal requirements.
  • Maintains all productivity rates and quality metrics as determined by department management.
  • Demonstrates ability to assist with inventory management from ordering/stocking, doing cycle counts and processing returns/recalls.
  • Performs basic buyer procedures including drug procurement required by department and consistent with departmental principles and Orlando Health policies and procedures.
  • Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
  • Maintains compliance with all Orlando Health policies and procedures.
  • Assumes responsibility for professional development and continuing education and improvement activities.
  • Actively participates in Process Improvement and Quality Management programs.
  • Responsible for adherence to all federal and state regulations related to the practice of pharmacy.
  • Competencies: Exhibit excellent leadership, communication and relationship building skills, and the ability to provide quality care and service.
Qualifications
  • High School diploma or equivalent G.E.D required.
  • Knowledge of Microsoft Office products including Outlook, Word, Excel, PowerPoint.
  • Two (2) years of retail, hospital, specialty or mail-order pharmacy experience required.
  • Maintains current Pharmacy Technician registration with Florida Board of Pharmacy.
Employment Type: FULL_TIME

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