Technician I, Prior Authorizations

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

📋 Description

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

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

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

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

• Make outbound calls as necessary.

• Review and process prior authorization requests received via fax and ePA.

• Monitor and respond to inquiries through departmental mailboxes.

• Enter prior authorization requests and confirm necessary documentation.

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

• Examine medical records and clinical documentation for medical necessity and appropriateness.

• Assist with appeals for denied or rejected prior authorization requests.

• Document patient information, medical codes, and authorization status in electronic systems.

• Identify process inefficiencies and suggest improvements.

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

• Stay updated on industry regulations, medical coding guidelines, and prior authorization standards.

• Adhere to 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 required.

• Consistent and reliable attendance is essential.

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

• Willingness to travel as required.

• Ability to manage workload by handling inbound calls and fax requests with professionalism and courtesy.

• Compliance with departmental, company, state, and federal regulations when processing information.

• Capability to maintain a privacy- and security-compliant home office environment.

• Ability to safeguard confidential information from being accessed or overheard by others at home.

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

• Ability to talk on the phone for long durations, 90–100% of the time.

• Proficiency in reading a computer screen for lengthy periods, 100% of the time.

🏝️ 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 to support physical, emotional, and financial well-being.

• Home-based work environment.