Prior Authorizations Technician I

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

📋 Description

• Handle incoming calls from providers, pharmacies, members, and other callers, delivering professional phone support through the criteria-based prior authorization process.

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

• Redirect clinical queries, escalations, and judgment-related issues to the pharmacist team.

• Initiate outbound calls as necessary.

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

• Monitor and respond to inquiries through departmental mailboxes.

• Manage incoming calls, faxes, and ePA requests in accordance with established standards.

• Adhere to departmental, company, state, and federal guidelines when processing information.

• Communicate the determination status and outcomes with internal teams, including seniors, pharmacists, and appeals departments.

• Identify and escalate clinical questions to the pharmacist team.

• Perform additional tasks such as handling faxes, sorting, managing email boxes, and maintaining the CAS system.

⛳️ Requirements

• Minimum of 6 months experience in Customer Service or as a Pharmacy Technician.

• High School Diploma or equivalent GED.

• Basic computer proficiency.

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

• Essential keyboarding abilities.

• Capability to multitask and utilize multiple system applications concurrently.

• Fundamental pharmaceutical knowledge, including terminology, calculations, and protocols.

• Ability to work independently, utilize available resources, and deliver high-quality work.

• Capacity to absorb information, show motivation, pursue development, and solve problems.

• 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.

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

• Consistent and reliable attendance.

• Willingness to work mandatory overtime or an extended work week as necessary.

• Readiness to travel when required.

• Capacity to sit for extended periods, engage in phone conversations for prolonged durations, and read from a computer screen for extended periods.

• Home workspace must adhere to CVS Health privacy and security policies.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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