Prior Authorizations, Technician I

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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

• Take 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 requests, and ePA requests according to established standards • Communicate determination status and results with internal groups, including seniors, pharmacists, and appeals • Identify and elevate clinical inquiries to the pharmacist team • Perform additional duties such as faxes, sorting, email boxes, and CAS maintenance

🎯 Requirements

• 6 months of Customer Service/Pharmacy Technician experience • High School Diploma or equivalent GED • Basic computer skills • Knowledge of Microsoft Office Suite, including Excel and Word; Access, Outlook, PowerPoint, and Visio preferable • Keyboard skills • Ability to multitask and use multiple system applications simultaneously • Basic pharmaceutical knowledge of terminology, calculations, and protocols • Ability to use available resources independently and provide high-quality work • Ability to absorb information, display motivation, seek development, and problem solve • Ability to adapt to workflow changes and shifting priorities • Excellent written, verbal, grammar, and listening communication skills • Ability to work with a diverse internal and external customer base in a friendly and confident manner • Ability to maintain confidentiality of PHI (Protected Healthcare Information) • Regular and predictable attendance • Willingness to work mandatory overtime/extended work weeks when needed • Willingness to travel when needed • Ability to comply with departmental, company, state, and federal requirements • Ability to effectively manage work volume while handling inbound calls and fax requests

🏖️ 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