Technician I, Prior Authorizations

About the role

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

The Technician I Prior Authorizations takes in-bound calls from providers, pharmacies, members, and others, providing professional and courteous phone assistance through the criteria-based prior authorization process. Maintains complete, timely, and accurate documentation of reviews. Transfers all clinical questions, escalations, and judgment calls to the pharmacist team. Assists with other duties as needed, including but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes, and other duties as assigned by the leadership team.

Responsibilities

• Effectively manage work volume by handling inbound calls, fax, and ePA requests utilizing appropriate courteous and professional behavior based upon established standards. 40%
• Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers. 40%
• Communicate with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc.). 10%
• Identify and elevate clinical inquiries to the pharmacist team as appropriate. 5%
• Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc. 5%

Requirements

• Able to apply basic computer skills.
• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable.
• Keyboard skills essential.
• Must be able to multitask and utilize multiple system applications simultaneously.
• Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.
• Must be able to utilize available resources independently and provide high-quality work.
• Must be able to absorb presented information, display motivation, seek development, and problem-solve.
• Ability to adapt and change with workflow and shifting priorities.
• Must possess excellent written, verbal, grammar, and listening communication skills.
• Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.
• Ability to maintain confidentiality of PHI (Protected Healthcare Information).
• 6 months of Customer Service/Pharmacy Technician Experience.
• Regular and predictable attendance.
• Must be able to work mandatory overtime/extended work week when needed.
• Must be able to travel when needed.
• High School Diploma or equivalent GED.

Physical Requirements

• Long periods of sitting (up to 100%).
• Talking on the phone for extended periods of time (90-100%).
• Reading a computer screen for extended periods of time (100%).

This is a home office position. Employee must ensure their workspace complies with CVS Health privacy and security policies and procedures. Information on computer screens must not be accessible or viewable by others. Telephone conversations involving confidential information must not be audible to others present in the home. Any CVS equipment or documents may not be accessible by others inside or outside of business hours. When a computer is not in use, it should remain locked or off to secure confidential information.

Pay

The typical pay range for this role is $17.00 - $28.46 per hour. This pay range represents the base hourly rate for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.

Schedule

Full-time position with anticipated weekly hours of 40.

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.