Pharmacy Technician - Prior Authorization - Work From Home

About the role

Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation. Reviews potential prior authorization denial language to ensure NCQA requirements are met. Follows prior authorization workflow, policies, and procedures during the course of the workday.

Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions. Maintains a balance of productivity, quality and timeliness of work.

Excellent attendance is required. Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions. Successful pharmacy technicians will possess good written and verbal communication skills.

Responsibilities

• Process prior authorization requests via phone, fax, or electronically
• Perform clinical research using computer resources, criteria, and medication guidelines
• Complete prior authorization approvals and denials before expiration
• Maintain accurate and timely documentation
• Review denial language to meet NCQA requirements
• Follow prior authorization workflows, policies, and procedures
• Handle high-volume calls from providers, pharmacies, and internal partners
• Communicate prior authorization status or decisions using computer resources
• Balance productivity, quality, and timeliness of work
• Participate in training, continuing education, and team/departmental meetings

Requirements

• National Pharmacy Technician certification and Arizona or applicable state Pharmacy Technician license, current and in good standing (must be maintained)
• Between 1-5+ years of Pharmacy Prior Authorization processing experience
• Ability to multi-task and prioritize work
• Ability to adjust based on business or department needs
• Good organization skills
• High School diploma or G.E.D.
• Own home internet access with minimum speed of 100mbps download (hard-wired Ethernet preferred)
• Secure workspace/office in your home
• High-level skill working with PC (e.g., using mouse and keyboard, navigating multiple systems and screens)

Preferred Qualifications

• Retail or Hospital experience
• Managed Care or Medicaid experience
• AS400 experience
• Proficiency in using computerized resources and software applications
• Proficiency with Microsoft applications (Excel, Word, and Outlook)
• Knowledge in pharmacy practices, procedures, and ability to read and understand clinical information
• Working knowledge of drug dosage forms, drug strength, generic and brand name equivalents

Schedule

Hours of operation for Aetna Pharmacy Prior Authorization are between 5:00 AM to 7:00 PM (may vary by time zone). Pharmacy Technicians work 8-hour shifts that may fall within these hours. Overnight shifts may be available but are not guaranteed. Work schedule is approximate and hours/days may change based on company needs.

• Full-time position requiring 40 hours per week as scheduled, including weekends and holidays
• Rotating weekend schedule may be required
• Ability to work extended hours when necessary

Pay

The typical pay range for this role is $18.50 - $35.29 per hour. This range represents the base hourly rate for all positions in the job grade. The actual base salary offer will depend on factors including experience, education, geography, and other relevant considerations. This position is also eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families, including:

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources based on eligibility