Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Pharmacy Prior Authorization Representative
Location
EST (UTC-5)
Posted
2 days ago
Salary
$17 - $26 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Pharmacy Prior Authorization Representative
The Cigna Group
Role Description The job profile for this position is Pharmacy Prior Authorization Representative, which is a Band 1 Professional Career Track Role. If you are organized, patient focused, and ready to grow in healthcare, this role is a great place to start. As a Prior Authorization Representative, you will help patients get approval for Enteral Nutrition services by working with insurance companies, care teams, and providers. You build strong communication skills, and support a team that is focused on timely, compassionate service. The Prior Authorization Representative supports the authorization process for enteral services. This includes: - Submitting new and renewal requests - Following up with insurance plans - Helping collect medical documents - Sharing updates with patients, prescribers, and internal teams This role is ideal for an early career candidate who enjoys details, teamwork, problem solving, and helping patients move through the care process with less delay. Hours: 8:30am-5pm EST, Monday-Friday Responsibilities - Submit initial and renewal prior authorization requests through payer portals, phone, fax, or other approved methods. - Track open requests and follow up on time to help reduce delays in care. - Review information for accuracy and completeness before sending requests to insurance plans. - Work with clinicians and internal teams to gather documents needed to support authorization requests. - Share clear updates with patients, prescribers, and team members about approvals, denials, or next steps. - Respond to email, chat, and other requests in a timely and professional way. - Manage daily tasks and priorities while meeting team quality and productivity goals. - Keep patient information private and document work accurately. Qualifications - High school diploma or GED. - Minimum 1 year of experience in customer service, administrative support, healthcare support, insurance, call center, data entry, or a related role. - Basic knowledge of medical terminology. - Comfort using computers and Microsoft Office applications, including Outlook, Word, and Excel. - Clear written and verbal communication skills. - Strong attention to detail and ability to stay organized while managing multiple tasks. - Customer-focused mindset and ability to work well with patients, providers, and internal teams. - Ability to handle confidential patient information with care. Preferred Qualifications - Experience in healthcare, insurance verification, prior authorization, patient access, billing, pharmacy, home infusion, or durable medical equipment (DME). - Familiarity with payer websites, insurance eligibility, coordination of benefits, formularies, denials, or appeals. - Experience working in a fast-paced team environment where accuracy and follow-up are important. Benefits - Hourly rate of 17 - 26 USD, depending on relevant factors, including experience and geographic location. - Eligible to participate in an annual bonus plan. - Comprehensive range of health-related benefits including medical, vision, dental, and well-being and behavioral health programs. - 401(k) and company paid life insurance. - Tuition reimbursement. - A minimum of 18 days of paid time off per year, paid holidays, and leaves of absence.
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