We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Job Summary
The Tech I, Prior Authorizations takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.
The Tech I will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.
Additional responsibilities to include but not limited to the following:
Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards.
Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc.)
Identify and elevate clinical inquiries to the pharmacist team as appropriate.
Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc.
Required Qualifications
6 months experience in customer service or call center environment
Must be able to work from home, this is a 100% work from home position
Have wired high speed internet
Able to apply basic computer skills. Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.
Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.
Preferred Qualifications
Must be able to multitask and utilize multiple system applications simultaneously.
Must be able to utilize available resources independently and provide high quality work.
Must be able to absorb presented information, display motivation, seek development and problem solve.
Ability to adapt and change with workflow and shifting priorities.
Must possess excellent written, verbal, grammar, and listening communication skills.
Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.
Ability to maintain confidentiality of PHI (Protected Healthcare Information).
Education
High School Diploma or equivalent GED
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 - $28.46This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.