Authorization Representative II - BioPlus Specialty Pharmacy

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for section headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Include only sections with real specific content. Remove boilerplate, navigation, EEO, etc. Keep substantive info. Let's parse the posting. Title: Authorization Representative II – BioPlus Specialty Pharmacy Locations: 3200 Lake Emma Rd, Lake Mary, FL 32746 Schedule: Monday - Friday, 8:00-5:00 Hybrid: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. 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. The Authorization Representative II will be 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 - 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 Qualifications: - 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. - Oncology experience preferred. Then there is a paragraph about "Please be advised that Elevance Health only accepts resumes for compensation from agencies..." That's boilerplate about unsolicited resumes; we should remove. Then "Who We Are" about Elevance Health: description. Could be "About the role" or "About the company"? The instruction: Use headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We need to map content. We have location and schedule info: schedule Monday-Friday 8-5, hybrid 1-2 days in office. That's schedule. We have responsibilities: the bullet list under "How You Will Make An Impact". That's responsibilities. We have minimum qualifications: that's qualifications. We have preferred skills: that's skills. We have about the role: maybe the description of BioPlus and Elevance Health and the role's purpose. Could be "About the role". Also location maybe part of About the role? Could include location in a paragraph. We have benefits: The posting mentions "We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few." That's benefits. Pay: Not specified; no pay info. So we should NOT include Pay section. Schedule: we have schedule info. We also have location: maybe include in About the role or as separate? There's no heading for location; we can embed in About the role paragraph. We need to avoid boilerplate: remove EEO, vaccination policy, etc. Also remove "Please be advised that Elevance Health only accepts resumes..." etc. Also remove "Who We Are" maybe we can incorporate into About the role but need to ensure not to include EEO etc. The "Who We Are" paragraph about Elevance Health being a Fortune 25 company etc is substantive about company; could be part of About the role. However we must ensure not to include EEO statements etc. The "Who We Are" paragraph includes: "Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve." That's okay. Then "How We Work" includes culture description; could be part of About the role but maybe not needed. However we can include as part of About the role if we want to keep substantive info. But we need to avoid too many thin sections; we can combine. We also have "The health of our associates and communities is a top priority..." includes vaccination requirement; that's maybe boilerplate but it's a specific policy about vaccination. Could be considered part of Benefits? Not exactly. It's a requirement. Might be considered part of Requirements? It's a condition of employment. Might be considered as part of Qualifications? It's a condition: "We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation." This is a specific requirement. Should we include? It's substantive. Could be part of Requirements or Qualifications. But the instruction: include sections only when posting has real specific content. It does have content about vaccination requirement. Could be placed under Requirements or maybe a separate section like "Requirements". However we already have Requirements for qualifications. Might be better to add a note under Requirements. But we must not invent sections not in list; we can only use the given headings. So we could add vaccination requirement under Requirements (maybe as a bullet). But the heading "Requirements" is ambiguous: could be job requirements (experience, education). We already have Qualifications for education/experience. Could treat Requirements as other job requirements (like vaccination, location, schedule). But schedule already has its own section. So we could put vaccination under Requirements. But we need to decide: we have headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We have content for About the role (company description, role purpose). Responsibilities (bullet list). Qualifications (minimum qualifications). Skills (preferred skills). Benefits (total rewards). Schedule (schedule). Possibly Requirements (vaccination, location commuting requirement). Also location itself maybe part of About the role. We must not include Pay (no info). So omit Pay heading. We must not include empty sections. Now we need to format: Use

for each section heading. Then under each heading, use

for prose,

• for lists. We need to preserve all substantive information; do not invent or summarize away detail. Let's extract exact phrasing where possible. About the role: Could combine the description of BioPlus and Elevance Health and the role's purpose. Original text: "BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. 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. The Authorization Representative II will be responsible for the administration of prior authorizations requests for patients whose health plan requires drug prior authorizations for different therapy types." Also location: "Locations: 3200 Lake Emma Rd, Lake Mary, FL 32746" Hybrid schedule description: "Schedule: Monday - Friday, 8:00-5:00 Hybrid: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law." We could put location and hybrid note under About the role or Schedule? The schedule heading is for schedule specifics; location maybe separate but we have no heading for location. Could include location in About the role paragraph. We also have "Who We Are" and "How We Work" paragraphs. Might be considered part of About the role as well. Let's decide to include About the role as a paragraph that includes: - BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. - BioPlus offers consumers and providers an unparalleled level of service that’s easy and focused on whole health. - Through 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. - The Authorization Representative II will be responsible for the administration of prior authorizations requests for patients whose health plan requires drug prior authorizations for different therapy types. - Located at 3200 Lake Emma Rd, Lake Mary, FL 32746. - Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. - At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We could keep that as prose. Now Responsibilities: bullet list from "How You Will Make An Impact". Keep exact phrasing. - 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. Note: The bullet list originally had capitalization and punctuation; we can keep as is. Now Qualifications: Minimum Qualifications text: "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." We could also include vaccination requirement under Requirements? Let's see. Requirements: Could include vaccination requirement and commuting distance note. Vaccination: "We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation." Commuting distance note: "Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law." We could combine these into a <