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 and courteous phone support throughout the criteria-based prior authorization process.

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

• Refer clinical questions, 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 respond to inquiries in department mailboxes.

• Manage the volume of inbound calls, faxes, and ePA requests in accordance with established standards.

• Communicate determination status and outcomes with internal groups, including seniors, pharmacists, and appeals.

• Identify and escalate clinical inquiries to the pharmacist team.

• Perform additional tasks, including faxes, sorting, managing email boxes, and maintaining the CAS.

⛳️ Requirements

• A 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, including Excel and Word; knowledge of Access, Outlook, PowerPoint, and Visio is preferable.

• Essential keyboarding abilities.

• Capability to multitask and utilize multiple system applications concurrently.

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

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

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

• Adaptability to workflow changes and shifting priorities.

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

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

• Commitment to maintaining the confidentiality of Protected Health Information (PHI).

• Regular and predictable attendance is essential.

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

• Availability to travel when necessary.

• Ability to effectively manage workload while handling inbound calls and fax requests.

• Compliance with departmental, company, state, and federal guidelines is required.

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

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

• Capacity to read a computer screen for prolonged periods, 100% of the time.

• Home workspace must adhere to CVS Health's privacy and security policies; confidential screens, conversations, equipment, and documents must be properly secured.

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Home-based work environment.