Prior Authorization Representative (PAR) Job Description

Role Summary

The Prior Authorization Representative (PAR) reviews and responds to phone and/or fax inquiries from members and/or health care professionals and assists them with medication prior authorizations. *

In this role, system documentation is reviewed, and information is provided in a straightforward, empathetic manner.

*Prior authorization is a process to determine if a prescribed medication is covered by a member's current health plan.

Responsibilities

• Respond primarily to phone inquiries from members, providers and/or pharmacies. (Fax inquiries may be part of the role.)

• Facilitate prior authorization requests.

• Utilize multiple applications to obtain information.

• Follow standard operating procedures (i.e., dept/corporate documentation, HIPAA regulations etc.) to provide accurate information and outcome.

• Pro- actively research and resolve issues, seeking assistance as needed.

• Maintain accurate and complete documentation of inquiries.

• Work collaboratively with others to ensure best practices are applied.

• Understand and strive to meet/exceed call center and other business metrics.

• Provide excellent and consistent customer service.

• Attend training classes as assigned.

• Work on tasks or projects as assigned.

Qualifications

• High School Diploma / GED

• 1+ years call center customer service experience

• Excellent customer service and communication skills

• Strong organizational skills

• Computer skills; including intermediate proficiency in Microsoft Outlook, working knowledge of Windows and the ability to easily navigate across multiple screens and applications.

• Healthcare background preferred.

• Ability to remain calm and helpful, even when dealing with difficult situations.

• Flexibility to support extended hours and overtime as determined by business needs to meet customer expectations.

• Able to attain 100% attendance throughout training/on the job training and maintain excellent attendance beyond.

• Must live in a DoD SCA County

• Must work any schedule between hours of operation which can range between (but not limited to) 7:00am - 10:00pm Eastern time, Monday through Friday.

• Training schedule may vary, however typically 9:00 am - 5:30 pm Easter time, Monday through Friday for 4 weeks and an additional 2 weeks for on-the-job training.

Work from Home Requirements

• 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.

Role Competencies

ACTION ORIENTED

INTERPERSONAL SAVVY

INSTILLS TRUST

CUSTOMER FOCUS

PLANS AND ALIGNS

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.

For this position, we anticipate offering an hourly rate of 17.75 - 26 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here (https://jobs.thecignagroup.com/us/en/benefits) .

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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.