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Be Part of an Extraordinary Team

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.

Build the Possibilities. Make an Extraordinary Impact.

LOCATION : This position will work ONSITE 5 days/week at our office at 700 N Broadway Denver, CO 80273. Candidates must reside within 50 miles or 1-hour commute each way of this location.

SCHEDULE : Monday- Friday

HOURS : Monday through Friday; you will be assigned one of the following:

• 8 AM-5 PM

• 9 AM-6 PM

• 10 AM-7 PM

The Authorization Representative II is responsible for the administration of prior authorizations requests for patients whose health plan requires drug prior authorizations for different therapy types.

How you will make an impact:

Primary duties may include, but are not limited to:

• Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards.

• Assists with the completion of medical necessity documentation to expedite approvals and ensures that appropriate follow up is performed.

• Collaborates with other departments to assist in obtaining prior authorizations/appeals.

• Document insurance company interactions and all prior authorization information in system.

• Reviews insurance denials and submit appeals as permitted by payor.

• Contacts physician offices as needed to obtain demographic information or medical data.

Minimum Requirements:

• Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations, and a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Specialty pharmacy experience highly preferred.

• Medical terminology training preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $16.96 to $27.98.

Location: Colorado

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.