Utilization Management Representative I (REMOTE – US) at Elevance Health

Utilization Management Representative I (REMOTE – US)
Elevance Health
Altamonte Springs, FL, USA

Full–time

Job highlights

Qualifications

•Requires HS diploma or GED and a minimum of 1 year of pharmacy prior authorizations or pharmacy billing experience; or any combination of education and experience which would provide an equivalent background
•Specialty pharmacy experience

Responsibilities

•As a Utilization Management Representative I, you will be responsible for coordinating cases for precertification and prior authorization review
•Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers
•Review prescription for accuracy of prescribed treatment regimen prior to submission of authorization
•Process/reverse online claims to confirm authorization outcome
•Completes status check with insurance company regarding receipt and outcome of prior authorization
•Perform call to prescriber office for status of authorization or request for additional information
•Responsible for all documentation of authorization statuses into CPR+ progress notes
•Managing incoming calls or incoming post services claims work
•Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
•Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner

Job description

Location: Remote (US)

BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies . Together, CarelonRx and BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.

As a Utilization Management Representative I, you will be responsible for coordinating cases for precertification and prior authorization review.

Primary duties may include, but are not limited to:
• Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers.
• Review prescription for accuracy of prescribed treatment regimen prior to submission of authorization.
• Process/reverse online claims to confirm authorization outcome.
• Completes status check with insurance company regarding receipt and outcome of prior authorization.
• Perform call to prescriber office for status of authorization or request for additional information.
• Responsible for all documentation of authorization statuses into CPR+ progress notes
• Managing incoming calls or incoming post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

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Minimum Requirements:
• Requires HS diploma or GED and a minimum of 1 year of pharmacy prior authorizations or pharmacy billing experience; or any combination of education and experience which would provide an equivalent background.

Minimum Requirements:
• Specialty pharmacy experience

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