Prior Authorizations, Technician I

This is a fully remote position, open to applicants in Florida.

📋 Description

• Manage incoming calls from providers, pharmacies, members, and other individuals through the criteria-based prior authorization process.

• Offer professional and courteous assistance over the phone.

• Ensure thorough, timely, and accurate documentation of reviews.

• Refer clinical inquiries, escalations, and judgment calls to the pharmacist team.

• Initiate outbound calls as necessary.

• Review and process prior authorizations received via fax and electronic prior authorization (ePA).

• Monitor and address inquiries in the department mailbox.

• Handle inbound calls, faxes, and ePA requests in accordance with established standards.

• Adhere to departmental, company, state, and federal regulations while processing information.

• Communicate determination statuses and outcomes with internal teams, including seniors, pharmacists, and appeals.

• Recognize and escalate clinical inquiries to the pharmacist team.

• Carry out additional assigned tasks, including managing faxes, sorting, email boxes, and CAS maintenance.

⛳️ Requirements

• Fundamental computer skills.

• Familiarity with Microsoft Office Suite, including Excel and Word; knowledge of Access, Outlook, PowerPoint, and Visio is preferred.

• Essential keyboarding skills.

• Capability to multitask and utilize multiple system applications simultaneously.

• Basic understanding of pharmaceutical terminology, calculations, and protocols.

• Ability to work autonomously using available resources while delivering high-quality work.

• Strong motivation, a focus on development, and problem-solving skills.

• Flexibility to adapt to changes in workflow and shifting priorities.

• Exceptional written, verbal, grammar, and listening communication skills.

• Ability to engage with a diverse internal and external customer base in a friendly and confident manner.

• Capacity to maintain confidentiality of Protected Health Information (PHI).

• Minimum of 6 months experience in customer service or as a pharmacy technician.

• Commitment to regular and predictable attendance.

• Willingness to work mandatory overtime or extended work weeks as needed.

• Openness to travel when required.

• High school diploma or equivalent GED.

• Ability to sit for extended periods, up to 100% of the time.

• Capacity to engage in phone conversations for long durations, 90–100% of the time.

• Ability to read a computer screen for extended periods, 100% of the time.

• Home workspace must comply with CVS Health privacy and security policies.

• Computer screens and confidential phone conversations must remain inaccessible and inaudible to others in the home.

• CVS equipment and documents must be secured, and computers locked or powered down 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.

• Additional resources supporting physical, emotional, and financial well-being.