Prior Authorizations, Technician I

About the role

As a Tech I Prior Auth at CVS Health, you’ll take inbound calls from providers, pharmacies, members, and others, providing professional and courteous phone assistance through the criteria-based prior authorization process. You’ll maintain complete, timely, and accurate documentation of reviews, transfer clinical questions or escalations to the pharmacist team, and assist with other duties such as outbound calls, reviewing and processing Prior Auths received via fax and ePA, monitoring department mailboxes, and other tasks assigned by leadership.

Responsibilities

• Effectively manage work volume by handling inbound calls, faxes, and ePA requests with courteous and professional behavior (40% of time).
• Comply with departmental, company, state, and federal requirements to ensure accuracy of information provided to internal and external customers (40% of time).
• Communicate with internal groups (e.g., seniors, pharmacists, appeals) regarding determination status and results (10% of time).
• Identify and escalate clinical inquiries to the pharmacist team as appropriate (5% of time).
• Perform other duties as assigned, such as fax processing, email management, CAS maintenance, and sorting (5% of time).

Requirements

• 6 months of customer service or pharmacy technician experience.
• Regular and predictable attendance.
• Ability to work mandatory overtime or extended hours when needed.
• Ability to travel when required.
• High school diploma or equivalent (GED).

Skills

• Basic computer skills, including proficiency in Microsoft Office Suite (Excel and Word required; Access, Outlook, PowerPoint, and Visio preferred).
• Strong keyboard skills and ability to multitask using multiple system applications simultaneously.
• Basic pharmaceutical knowledge, including terminology, calculations, and protocols.
• Ability to work independently, absorb information, seek development, and problem-solve.
• Adaptability to changing workflows and shifting priorities.
• Excellent written, verbal, grammar, and listening communication skills.
• Ability to interact confidently and professionally with a diverse customer base (internal and external).
• Commitment to maintaining confidentiality of Protected Health Information (PHI).

Physical Requirements

• Long periods of sitting (up to 100% of the time).
• Extended periods of talking on the phone (90-100% of the time).
• Prolonged reading of a computer screen (100% of the time).

Work Environment

This is a home office position. Your workspace must comply with CVS Health privacy and security policies and procedures, including:

• Ensuring computer screens and confidential information are not accessible or viewable by others.
• Keeping telephone conversations involving confidential information inaudible to others in the home.
• Securing CVS equipment and documents to prevent access by others during and outside business hours.
• Locking or powering off computers when not in use to protect confidential information.

Schedule

• Full-time position with anticipated weekly hours of 40.

Pay

The typical pay range for this role is $17.00 - $28.46 per hour. The actual base salary offer will depend on factors such as 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 and other resources (based on eligibility).

Additional details about available benefits are provided during the application process and on Benefits Moments.