Technician I, Prior Authorizations

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $17 - $28 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 • Provide professional and courteous phone assistance through the criteria-based prior authorization process • 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 inquiries via department mailboxes • Enter prior authorization requests and verify required documentation • Verify insurance coverage to determine whether prior authorization is required • Inspect medical records and clinical documentation for medical necessity and appropriateness • Assist with appeals for denied or rejected requests • Document patient details, medical codes, and authorization status in electronic systems • Identify process inefficiencies and propose operational improvements • Communicate with healthcare providers to obtain information, clarify documentation, and communicate decisions or requirements • Maintain awareness of regulations, medical coding guidelines, and prior authorization changes through training and knowledge sharing • Ensure adherence to regulatory guidelines, company policies, and industry standards

🎯 Requirements

• 6 months of Customer Service/Pharmacy Technician Experience • High School Diploma or equivalent GED • Regular and predictable attendance • Willingness to work mandatory overtime/extended work week when needed • Willingness to travel when needed • Ability to manage work volume by handling inbound calls/fax requests using courteous and professional behavior • Compliance with departmental, company, state, and federal requirements when processing information • Ability to maintain accuracy of information provided to internal and external customers • Ability to work long periods sitting, talking on the phone, and reading a computer screen • Home workspace must comply with CVS Health privacy and security policies • Confidential computer information and telephone conversations must not be accessible or audible to others in the home

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Remote work from a home office • Comprehensive benefits package for eligible full-time colleagues