Prior Authorization Representative, CVS Health

CVS Health

Location:
United States, Work at Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 34.15 USD / Hour

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Job Description:

The Prior Authorization colleague 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. You will maintain complete, timely, and accurate documentation of reviews. As a Prior Authorization Representative you will make the determination if a complex request should be transferred to a pharmacist for assistance.

Job Responsibility:

Take in-bound calls from providers, pharmacies, members
Provide professional and courteous phone assistance through criteria-based prior authorization process
Maintain complete, timely, and accurate documentation of reviews
Make determination if complex request should be transferred to pharmacist for assistance
Handle outbound calls, reviewing and processing Prior Authorizations received via fax & ePA
Effectively manage work volume by handling inbound calls/fax/ePA requests
Comply with departmental, company, state, and federal requirements
Communication with other internal groups regarding determination status and results
Identify and elevate clinical inquiries to the pharmacist team as appropriate

Requirements:

6+ months of Customer Service experience
Call center environment experience preferred
Verifiable High School Diploma or GED required
Basic computer skills
Knowledge of Microsoft Office Suite: Excel and Word required
Ability to multitask and utilize multiple system applications simultaneously
Basic pharmaceutical knowledge pertaining to terminology and protocols preferred
Must be able to utilize available resources independently
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 in a friendly and confident manner
Ability to maintain confidentiality of PHI (Protected Healthcare Information)
Regular and predictable attendance
Must have open availability from 8:00am - 8:00pm CST

Nice to have:

Knowledge of Microsoft Access, Outlook, PowerPoint, Visio
Basic pharmaceutical knowledge pertaining to terminology and protocols

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
No-cost tobacco cessation and weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
November 12, 2025

Expiration:
December 05, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Prior Authorization Representative