Prior Authorization Specialist – Operations

CVS Health Corporation; Nevada (IA); Hybrid; USD 48,712,000 - 97,854,000; Full time

Job summary

CVS Health is seeking a Technician I, Prior Authorizations to manage inbound calls from providers, pharmacies and members, guiding them through the prior authorization process. You will document reviews accurately and escalate to pharmacists as needed.

The role supports outbound calls, processing Prior Auths via fax and ePA, and responding to inquiries while collaborating with leadership to prioritize work and maintain PHI confidentiality.

Qualifications

• Basic computer skills with Microsoft Office Suite (Excel and Word required).
• Must multitask and use multiple systems simultaneously.
• Pharmaceutical terminology, calculations and protocols knowledge.
• Ability to maintain high quality work and confidentiality of PHI.

Responsibilities

• Handle inbound calls from providers, pharmacies and members through prior authorization.
• Document reviews completely and transfer clinical questions to pharmacists.
• Assist with outbound calls, review Prior Auths via fax/ePA and monitor department mailboxes.

Skills

Microsoft Office

Excel

Word

Outlook

Multitask

PHI privacy

Pharmaceutical knowledge

Communication skills

Data entry

Education

High School Diploma or GED

Job description

CVS Health is seeking a Technician I, Prior Authorizations to manage inbound calls from providers, pharmacies and members, guiding them through the prior authorization process. You will document reviews accurately and escalate to pharmacists as needed.

The role supports outbound calls, processing Prior Auths via fax and ePA, and responding to inquiries while collaborating with leadership to prioritize work and maintain PHI confidentiality.