Technician I, Prior Authorizations

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

📋 Description

• Handle inbound calls from healthcare providers, pharmacies, members, and various other callers.

• Offer professional and courteous phone support through the criteria-based prior authorization process.

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

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

• Initiate outbound calls as necessary.

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

• Monitor and respond to requests via departmental mailboxes.

• Input prior authorization requests and confirm that required documentation is included.

• Verify insurance coverage to ascertain if prior authorization is needed.

• Evaluate medical records and clinical documentation for medical necessity and suitability.

• Assist with appeals for denied or rejected requests.

• Record patient details, medical codes, and authorization status in electronic systems.

• Identify inefficiencies in processes and suggest operational enhancements.

• Communicate with healthcare providers to gather information, clarify documentation, and relay decisions or requirements.

• Stay informed about regulations, medical coding guidelines, and changes in prior authorization through training and knowledge sharing.

• Ensure compliance with regulatory guidelines, company policies, and industry standards.

⛳️ Requirements

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

• High School Diploma or equivalent GED.

• Consistent and reliable attendance.

• Willingness to work mandatory overtime or extended hours when necessary.

• Openness to travel when required.

• Capability to manage work volume by addressing inbound calls and fax requests with courtesy and professionalism.

• Adherence to departmental, company, state, and federal regulations when processing information.

• Ability to maintain the accuracy of information provided to both internal and external customers.

• Capacity to work for extended periods while sitting, talking on the phone, and reading from a computer screen.

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

• Confidential computer information and telephone conversations must be inaccessible or inaudible to others in the household.

🏝️ Benefits

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

• Coverage for medical, dental, and vision needs.

• Paid time off.

• Retirement savings options available.

• Wellness programs offered.

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

• Opportunity to work remotely from a home office.

• Comprehensive benefits package available for eligible full-time colleagues.