Prior Authorizations, Technician I

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $17 - $28 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Handle inbound calls from providers, pharmacies, members, and other callers through the criteria-based prior authorization process • Provide professional and courteous phone assistance • Maintain complete, timely, and accurate documentation of reviews • Transfer clinical questions, escalations, and judgment calls to the pharmacist team • Make outbound calls as needed • Review and process prior authorizations received via fax and ePA • Monitor and respond to department mailbox inquiries • Manage inbound calls, fax, and ePA request volume according to established standards • Comply with departmental, company, state, and federal requirements when processing information • Communicate determination status and results with internal groups, including seniors, pharmacists, and appeals • Identify and escalate clinical inquiries to the pharmacist team • Perform other assigned duties, including faxes, sorting, email boxes, and CAS maintenance

🎯 Requirements

• Basic computer skills • Microsoft Office Suite knowledge, including Excel and Word; Access, Outlook, PowerPoint, and Visio preferable • Essential keyboard skills • Ability to multitask and use multiple system applications simultaneously • Basic pharmaceutical knowledge of terminology, calculations, and protocols • Ability to work independently using available resources and provide high-quality work • Motivation, development orientation, and problem-solving ability • Ability to adapt to workflow changes and shifting priorities • Excellent written, verbal, grammar, and listening communication skills • Ability to deal with a diverse internal and external customer base in a friendly and confident manner • Ability to maintain confidentiality of PHI (Protected Healthcare Information) • At least 6 months of customer service or pharmacy technician experience • Regular and predictable attendance • Willingness to work mandatory overtime or an extended work week when needed • Willingness to travel when needed • High school diploma or equivalent GED • Ability to sit for long periods, up to 100% • Ability to talk on the phone for extended periods, 90–100% • Ability to read a computer screen for extended periods, 100% • Home workspace must comply with CVS Health privacy and security policies • Computer screens and confidential telephone conversations must not be accessible or audible to others in the home • CVS equipment and documents must be secured, and computers locked or turned off when not in use

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being