Prior Authorization Representative

If you're organised, patient-focused, and ready to grow in healthcare, this role is a great place to start. As a Prior Authorization Representative, you'll help patients get approval for Home Infusion and Enteral Nutrition services by working with insurance companies, care teams, and providers.

The Prior Authorization Representative supports the authorization process for home infusion and enteral services. This includes submitting new and renewal requests, following up with insurance plans, helping collect medical documents, and sharing updates with patients, prescribers, and internal teams.

Hours: 8:30am-5pm EST, Monday-Friday

Responsibilities

• Submit initial and renewal prior authorization requests through payer portals, phone, fax, or other approved methods.
• Track open requests and follow up on time to help reduce delays in care.
• Review information for accuracy and completeness before sending requests to insurance plans.
• Work with clinicians and internal teams to gather documents needed to support authorization requests.
• Share clear updates with patients, prescribers, and team members about approvals, denials, or next steps.
• Respond to email, chat, and other requests in a timely and professional way.
• Manage daily tasks and priorities while meeting team quality and productivity goals.
• Keep patient information private and document work accurately.

Qualifications

• High school diploma or GED.
• Minimum 1 year of experience in customer service, administrative support, healthcare support, insurance, call centre, data entry, or a related role.
• Basic knowledge of medical terminology.
• Comfort using computers and Microsoft Office applications, including Outlook, Word, and Excel.
• Clear written and verbal communication skills.
• Strong attention to detail and ability to stay organised while managing multiple tasks.
• Customer-focused mindset and ability to work well with patients, providers, and internal teams.
• Ability to handle confidential patient information with care.

Preferred Qualifications

• Experience in healthcare, insurance verification, prior authorisation, patient access, billing, pharmacy, home infusion, or durable medical equipment (DME).
• Familiarity with payer websites, insurance eligibility, coordination of benefits, formularies, denials, or appeals.
• Experience working in a fast-paced team environment where accuracy and follow-up are important.

As part of Evernorth Health Services, this role supports CarepathRx within our Pharmacy and Care Delivery organisation. Our team focuses on specialty pharmacy and infusion services in partnership with hospitals and health systems.

The anticipated hourly rate for this position is $17.75 - $26, 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 behavioural health programmes. 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.