Prior Authorization Representative- Evernorth- Remote

Role overview Coordinate prior authorization requests for home infusion and enteral nutrition services, helping patients and care teams move through insurance review with fewer delays. The role combines request submission, document gathering, follow-up, and clear communication with payers, providers, patients, and internal colleagues.

Responsibilities - Submit new and renewal authorization requests through payer portals, phone, fax, or other approved channels. - Monitor pending requests and follow up promptly with insurance plans. - Check requests for completeness and accuracy before submission. - Work with clinicians and internal teams to collect supporting medical documentation. - Communicate approval, denial, and next-step updates to patients, prescribers, and colleagues. - Document work accurately, protect confidential patient information, and manage daily priorities against quality and productivity goals.

Requirements - High school diploma or GED. - At least one year of experience in customer service, administration, healthcare support, insurance, call center work, data entry, or a related area. - Basic medical terminology and comfort with computers and Microsoft Outlook, Word, and Excel. - Clear written and verbal communication, strong organization, and close attention to detail. - Ability to manage multiple tasks, work well with patients and care teams, and handle confidential information appropriately.

Nice to have - Experience in healthcare, insurance verification, prior authorization, patient access, billing, pharmacy, home infusion, or durable medical equipment. - Familiarity with payer websites, eligibility, coordination of benefits, formularies, denials, or appeals.

Benefits and work setup - Schedule: Monday through Friday, 8:30 a.m.–5 p.m. Eastern. Remote work requires cable broadband or fiber internet with at least 10 Mbps download and 5 Mbps upload. - Anticipated pay is $17.75–$26 per hour, depending on experience and location, with expected eligibility for an annual bonus plan. - Benefits include medical, dental, and vision coverage, wellbeing programs, a 401(k), paid holidays, and at least 18 days of paid time off per year.