Prior Authorization Specialist I

CVS Health; Richmond (VA); On-site; USD 23,000 - 39,000; Full time

Job summary

CVS Health is seeking a Technician I for Prior Authorizations to handle inbound calls from providers, pharmacies, members, and others, delivering professional assistance and documenting reviews. The role includes supporting outbound calls, processing faxed Prior Auth requests, and routing clinical questions to pharmacists.

The position requires 6 months of customer service/pharmacy experience, strong multitasking, and solid pharmacy terminology knowledge.

Qualifications

• 6 months of Customer Service/Pharmacy Technician Experience
• Must be able to multitask and utilize multiple system applications simultaneously
• Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols
• Must be able to absorb presented information, display motivation and problem solve
• 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 Health Information)

Responsibilities

• Effectively manage work volume by handling inbound calls/fax/ePA requests 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.
• Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc).
• Identify and elevate clinical inquiries to the pharmacist team as appropriate.
• Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc.

Skills

Customer service

Multitasking

Computer literacy

Pharmacy terminology

Verbal communication

Data entry

confidentiality

Education

High School Diploma or GED

Tools

Microsoft Excel

Microsoft Word

Outlook

Job description

CVS Health is seeking a Technician I for Prior Authorizations to handle inbound calls from providers, pharmacies, members, and others, delivering professional assistance and documenting reviews. The role includes supporting outbound calls, processing faxed Prior Auth requests, and routing clinical questions to pharmacists.

The position requires 6 months of customer service/pharmacy experience, strong multitasking, and solid pharmacy terminology knowledge.