Prior Authorization Technician I

CVS Health; United States; On-site; USD 23,000 - 39,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus program

Paid time off

Health, dental, and vision coverage

Job summary

CVS Health is seeking a Technician I, Prior Authorizations to handle inbound calls from providers, pharmacies, and members, ensuring accurate documentation and timely processing of prior authorizations. You will transfer clinical questions to pharmacists and support appeals with required documentation.

Responsibilities include entering requests, verifying coverage, reviewing medical records for necessity, and communicating with providers to obtain needed information.

Qualifications

• 6 months of customer service/pharmacy technician experience.
• 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 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.

Responsibilities

• 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.

Skills

Customer service experience

Pharmacy technician experience

Education

High School Diploma or GED

Job description

CVS Health is seeking a Technician I, Prior Authorizations to handle inbound calls from providers, pharmacies, and members, ensuring accurate documentation and timely processing of prior authorizations. You will transfer clinical questions to pharmacists and support appeals with required documentation.

Responsibilities include entering requests, verifying coverage, reviewing medical records for necessity, and communicating with providers to obtain needed information.