Prior Authorization Specialist I — Ops & Support

CVS Health Corporation; Town of Florida (NY); Hybrid; USD 23,000 - 47,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health Corporation is seeking a Technician I, Prior Authorizations to handle inbound calls from providers, pharmacies, and members, ensuring thorough documentation and effective routing of clinical questions to pharmacists.

The role supports outbound communications, reviews Prior Authorizations via fax and ePA, and responds to inquiries while adapting to changing priorities in a fast-paced health care environment.

Qualifications

• Basic computer skills with MS Office; Excel and Word required.
• Ability to multitask and use multiple systems.
• Basic pharmaceutical knowledge of terminology and calculations.
• Ability to work independently and deliver high-quality work.
• Strong written, verbal, grammar, and listening communication skills.
• Maintain confidentiality of PHI (Protected Health Information).

Responsibilities

• Handle inbound calls from providers, pharmacies, members and others; provide professional and courteous assistance during prior authorization reviews.
• Document reviews completely and timely.
• Escalate clinical questions to the pharmacist team as needed.
• Assist with outbound calls and processing of Prior Authorizations received via fax and ePA.
• Monitor inquiries via department mailboxes and perform other duties as assigned by leadership.

Skills

Microsoft Excel & Word

Multitasking

Pharmaceutical terminology

Communication skills

Confidentiality

Adaptability

Education

High School Diploma or GED

Tools

Microsoft Excel

Outlook

PowerPoint

Visio

Job description

CVS Health Corporation is seeking a Technician I, Prior Authorizations to handle inbound calls from providers, pharmacies, and members, ensuring thorough documentation and effective routing of clinical questions to pharmacists.

The role supports outbound communications, reviews Prior Authorizations via fax and ePA, and responds to inquiries while adapting to changing priorities in a fast-paced health care environment.