Pharmacy Technician, Prior Authorizations Job at CVS Health (Work at Home, Florida)

Job Description

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. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Job Responsibility

Takes in-bound calls from providers, pharmacies, members, etc. providing professional and courteous phone assistance to all callers through the criteria based prior authorization process
Maintains complete, timely and accurate documentation of reviews
Transfers all clinical question, escalations and judgement calls to the pharmacist team
Assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auths received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team
Enters prior authorization requests submitted by healthcare providers, ensuring all required documentation is complete and accurate
Verifies insurance coverage to determine if prior authorization is required for specific medical procedures, treatments, or medications
Inspects medical records and clinical documentation to assess the medical necessity and appropriateness of the requested services or treatments
Assists in the preparation and submission of appeals for denied or rejected prior authorization requests, including gathering necessary supporting documentation
Documents relevant information into electronic systems, including patient details, medical codes, and prior authorization status
Communicates with team members and supervisors to identify process inefficiencies and propose solutions to streamline prior authorization operations
Communicates with healthcare providers to obtain additional information, clarify documentation, and communicate prior authorization decisions or requirements
Maintains awareness of updated industry regulations, medical coding guidelines, and changes in prior authorization requirements by participating in training sessions and knowledge-sharing activities
Ensures adherence to regulatory guidelines, company policies, and industry standards during the prior authorization process

Requirements

6 plus months of Customer Service/Pharmacy Technician Experience
Able to apply basic computer skills. Knowledge of Microsoft Office Suite: Excel and Word required
Access, Outlook, PowerPoint, Visio Preferable. Keyboard skills essential
Regular and predictable attendance
Colleague will be required to work mandatory overtime/extended work week when needed
Colleague will be required to travel when needed
Effectively manage work volume by handling inbound calls/fax request utilizing appropriate courteous and professional behavior based upon established standards
Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers
High School Diploma or equivalent GED

Nice to have

Must be able to multitask and utilize multiple system applications simultaneously
Basic pharmaceutical knowledge per tainting to terminology, calculations, and protocols
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)

What we offer

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs

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Pharmacy Technician, Prior Authorizations

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