Process Expert II (Prior Authorization)

About the position Process Expert II (Prior Authorization) Location: Candidates that live in Ohio, Nevada and Virginia are strongly preferred. 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. 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. Shift: Standard business hours; rotating weekends with flex opportunities and shifts up to 9:00pm, as needed. A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care. CarelonRx Pharmacy is now part of CarelonRx (formerly IngenioRx), a proud member of the Elevance Health family of companies. The CarelonRx Home Delivery Pharmacy will deliver a digital first pharmacy experience that is convenient, simpler to use, and more affordable for our patients and payors. Our Pharmacy model focuses on whole person care, providing the best member experience to drive adherence, affordability, and improved overall health outcomes by putting the patient first. The Process Expert II (Prior Authorization) supports a single operations department by participating in project and process work. Assist in the configuration of the prior authorization workflow tool, ensuring it is set up and maintained to support business operations effectively.

Responsibilities

• Researches operations workflow problems and system irregularities.
• Develops tests, presents process improvement solutions for new systems, new accounts and other operational improvements.
• Develops and leads project plans and communicates project status.
• Efficiently address and help facilitate support tickets, ensuring any issues affecting business operations are promptly addressed by appropriate party to maintain system reliability.
• Handle and coordinate change requests, working closely with internal teams and external partners to implement necessary adjustments seamlessly.

Requirements

• Requires a BA/BS and minimum of 5 years’ experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background.

Nice-to-haves

• Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements.
• Understanding of prior authorization processing.
• Working knowledge of PA Hub.
• Ability to work autonomously.
• Team oriented.
• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Benefits

• In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• 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.

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