Pharmacy Prior Authorization Representative - Evernorth - Remote (Finance)

Pharmacy Prior Authorization Representative - Evernorth - Remote (Finance)

In this pivotal role, Pharmacy Prior Authorization Representatives respond to phone inquiries from health care professionals and assist them with the medication prior authorization process, by delivering straight forward administrative and/or other basic business services in Pharmacy Operations

A successful candidate will be able to interact effectively and efficiently with health care professionals using excellent interpersonal and listening skills, critical thinking, and problem-solving skills. The ability to multitask and use computer-based resources effectively is essential.

Confidently able to educate and provide accurate responses to inquiries is crucial for success. As a Prior Authorization Representative, you will be part of a dedicated team which provides information regarding pharmacy benefits and drug coverage. This crucial role is on the front lines with healthcare professionals, responding and addressing each phone inquiry with care, detail, and most importantly, empathy.

Primary Responsibilities

• Collection of structured clinical data for prior authorization and non-formulary exception requests following the guidance provided in our online prior authorization tools and corresponding forms.
• Initial screening of requests based on guidance given by online prior authorization tools.
• Approves prior authorization requests if the data collected meets the approval specifications.
• Refers prior authorization requests that do not meet the approval specifications to a clinician for review.
• Independently responds to contacts ranging from routine to moderate complexity. May seek assistance with health care professionals for service issues of substantial complexity.
• Performs research to respond to inquiries and interprets policy provisions to determine the most effective response using established departmental procedures, HIPAA regulations, and corporate policies

• High School Diploma / GED
• 1+ years of call center experience
• Prior work from home experience
• Prior medical or pharmacy knowledge
• Reliable high-speed broadband internet, hard-wired connection. 10 Mbps for download / 5 MBPS for upload
• Quiet and private space designated for work without interruption.
• Excellent Customer Service
• Excellent interpersonal communication, attention to detail, and critical thinking skills are essential.
• Excellent computer skills, with familiarity of Microsoft office and have a working knowledge of Windows operating system.
• Tech savvy, with the ability to easily navigate across multiple screens and applications.
• Must work any schedule between 8:00am - 9:00pm EST.
• Training Schedule is 9:00 am - 5:30 pm EST, Monday through Friday for 4 weeks and an additional 2 weeks for on-the-job training.
• Flexibility to support extended hours and overtime as determined by business needs to meet customer expectations.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we\'re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.