Prior Authorizations Technician I
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Job Description
CVS Health prior authorization technician handling inbound calls, pharmacy reviews, and documentation from a Texas home office. Escalating clinical questions to pharmacists while processing fax and ePA requests.
Responsibilities:
- Take inbound calls from providers, pharmacies, members, and other callers, providing professional phone assistance through the criteria-based prior authorization process
- 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 inquiries through department mailboxes
- Manage inbound calls, fax, and ePA requests 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 elevate clinical inquiries to the pharmacist team
- Perform additional duties such as faxes, sorting, email boxes, and CAS maintenance
Requirements:
- 6 months of Customer Service/Pharmacy Technician Experience
- High School Diploma or equivalent GED
- 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, including terminology, calculations, and protocols
- Ability to work independently, use available resources, and provide high-quality work
- Ability to absorb information, demonstrate motivation, seek development, and solve problems
- Ability to adapt to workflow changes and shifting priorities
- Excellent written, verbal, grammar, and listening communication skills
- Ability to work with a diverse internal and external customer base in a friendly and confident manner
- Ability to maintain confidentiality of Protected Health Information (PHI)
- Regular and predictable attendance
- Willingness to work mandatory overtime or an extended work week when needed
- Willingness to travel when needed
- Ability to sit for long periods, talk on the phone for extended periods, and read a computer screen for extended periods
- Home workspace must comply with CVS Health privacy and security policies
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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