Technician I, Prior Authorizations

Job not on LinkedIn

🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – 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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 through 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 prior authorization requests • Document patient details, medical codes, and authorization status in electronic systems • Identify process inefficiencies and propose improvements • Communicate with healthcare providers to obtain information, clarify documentation, and communicate decisions or requirements • Stay current on industry regulations, medical coding guidelines, and prior authorization requirements • Follow 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 a privacy- and security-compliant home office workspace • Ability to protect confidential information from being viewed or heard by others in the home • 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%

🏖️ 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 • Home-based work environment