Prior Authorizations, Technician I

About the role

As a Tech I Prior Auth, you will handle in-bound calls from providers, pharmacies, members, and others, providing professional and courteous phone assistance through the criteria-based prior authorization process. You will maintain complete, timely, and accurate documentation of reviews, transfer clinical questions and escalations to the pharmacist team, and assist with additional duties such as outbound calls, 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%).
• Comply with departmental, company, state, and federal requirements to ensure accuracy of information provided to internal and external customers (40%).
• Communicate with internal groups (e.g., seniors, pharmacists, appeals) regarding determination status and results (10%).
• Identify and escalate clinical inquiries to the pharmacist team as appropriate (5%).
• Perform other duties as assigned, such as processing faxes, sorting, managing email boxes, CAS maintenance, etc. (5%).

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 and 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 utilize available resources independently and produce high-quality work.
• Strong problem-solving skills, motivation, and adaptability to 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%).
• Extended periods of talking on the phone (90-100%).
• Reading a computer screen for extended periods of time (100%).

This is a home office position. Your workspace must comply with CVS Health privacy and security policies, ensuring confidential information on computer screens and telephone conversations is not accessible or audible to others. CVS equipment and documents must remain secure and inaccessible outside of business hours.

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 (40 hours per week) includes a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. Eligible benefits may include:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.

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