Prior Authorizations, Technician I
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Job Description
CVS Health prior authorization technician supporting pharmacy and healthcare requests from a Florida home office. Processing calls, faxes, ePA submissions, documentation, and escalations to pharmacists.
Responsibilities:
- Handle inbound calls from providers, pharmacies, members, and other callers through the criteria-based prior authorization process
- Provide professional and courteous phone assistance
- Maintain complete, timely, and accurate documentation of reviews
- Transfer clinical questions, escalations, and judgment calls to the pharmacist team
- Make outbound calls as needed
- Review and process prior authorizations received via fax and ePA
- Monitor and respond to department mailbox inquiries
- Manage inbound calls, fax, and ePA request volume according to established standards
- Comply with departmental, company, state, and federal requirements when processing information
- Communicate determination status and results with internal groups, including seniors, pharmacists, and appeals
- Identify and escalate clinical inquiries to the pharmacist team
- Perform other assigned duties, including faxes, sorting, email boxes, and CAS maintenance
Requirements:
- Basic computer skills
- Microsoft Office Suite knowledge, including Excel and Word; Access, Outlook, PowerPoint, and Visio preferable
- Essential keyboard skills
- Ability to multitask and use multiple system applications simultaneously
- Basic pharmaceutical knowledge of terminology, calculations, and protocols
- Ability to work independently using available resources and provide high-quality work
- Motivation, development orientation, and problem-solving ability
- Ability to adapt to workflow changes and shifting priorities
- Excellent written, verbal, grammar, and listening communication skills
- Ability to deal with a diverse internal and external customer base in a friendly and confident manner
- Ability to maintain confidentiality of PHI (Protected Healthcare Information)
- At least 6 months of customer service or pharmacy technician experience
- Regular and predictable attendance
- Willingness to work mandatory overtime or an extended work week when needed
- Willingness to travel when needed
- High school diploma or equivalent GED
- Ability to sit for long periods, up to 100%
- Ability to talk on the phone for extended periods, 90–100%
- Ability to read a computer screen for extended periods, 100%
- Home workspace must comply with CVS Health privacy and security policies
- Computer screens and confidential telephone conversations must not be accessible or audible to others in the home
- CVS equipment and documents must be secured, and computers locked or turned off when not in use
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
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