Pharmacy Prior Authorization Senior Representative

Band 2 - P02109

**Selected candidate will work at home near Warrendale, PA until Covid restrictions are listed. Then the selected candidate is required to move to work in the office: 3000 Ericsson Dr., Warrendale, PA 15086

The Pharmacy Prior Authorization Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully liaise with Payers, Pharma, Physicians and Patients. This role directly interfaces with external clients and requires a high level of independent judgment in order to establish and maintain effective relationships with clients to gain their trust and support. Relies on experience and knowledge of industry best practices to identify exposures to the company and facilitates leadership's knowledge of pending referrals that may have an adverse impact on company goals and the patient experience. Acts as a liaison between both internal and external resources to reduce client abrasion, facilitate the timely processing of referrals and provide accurate status reporting to clients.

ESSENTIAL FUNCTIONS

• Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.


• Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.


• Contacts benefit providers to gather policy benefits/limitations.


• Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).


• Directly interfaces with external clients.


• Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.


• Provide expert assistance to clients on patient status.


• Liaison for company providing referral status reporting.


• May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome.


• Handle Escalations.


• Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate.


• Completes other projects and additional duties as assigned.

QUALIFICATIONS

• High school diploma or GED required, bachelor's degree preferred.


• 3-5 years of relevant working experience.


• Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.


• Exceptional customer service skills are required


• Excellent phone presentation and communication skills. Proven ability to de-escalate situations during challenging calls.


• Able to be successful in a fast pace environment which is predominantly spent on the phone working thru a variety of tasks.


• Intermediate data entry skills and working knowledge of Microsoft Office.


• Patient Access knowledge.


• Extensive knowledge of ESI products and services a must.


• Experience training and coaching less experienced staff with patience to explain details and processes repeatedly.


• Demonstrated ability to handle challenging customers in a professional manner.


• Ability to adapt in a dynamic work environment and make decisions with minimal supervision.


• Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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.