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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

The Tech I Prior Auth takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews.  Transfers all clinical questions, escalations and judgement calls to the pharmacist team.

 

The Tech I will also assist with other duties as needed to include but not limited to:  outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.

Required Qualifications

Responsibilities % Time*

Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards. 40%

Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers. 40%

Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc). 10%

Identify and elevate clinical inquiries to the pharmacist team as appropriate. 5%

Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc. 5%

REQUIRED SKILLS & OTHER MINIMUM REQUIRED QUALIFICATIONS:    

-    Able to apply basic computer skills.  Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable.  Keyboard skills essential.

-    Must be able to multitask and utilize multiple system applications simultaneously.

-    Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.

-    Must be able to utilize available resources independently and provide high quality work.

-    Must be able to absorb presented information, display motivation, seek development and problem solve.

-    Ability to adapt and change with workflow and shifting priorities.

-    Must possess excellent written, verbal, grammar, and listening communication skills.

-    Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.

-Ability to maintain confidentiality of PHI (Protected Healthcare Information).

 

ESSENTIAL FUNCTIONS:  Essential job functions are the fundamental duties of a position, the things a person holding the job absolutely must be able to do.

 

Essential Functions

1. Regular and predictable attendance (Do not delete – keep for all jobs)

2. Colleague will be required to work mandatory overtime/extended work week when needed (Do not delete – keep for all jobs)

3. Colleague will be required to travel when needed (Do not delete – keep for all jobs)

4.  Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards.

5.  Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.

Physical Requirements

1.  Long periods of sitting (up to 100%)

2.  Talking on the phone for extended periods of time (90-100%)

3.  Reading a computer screen for extended periods of time (100%)

 

WORK ENVIRONMENT (Home Office):  

Employee has a workspace that ensures compliance with CVS Health privacy and security policies and procedures. Information on computer screen must not be accessible or viewable by others. Telephone conversations involving confidential information must not be audible to others present in the home. Any CVS equipment or documents may not be accessible by others inside or outside of business hours. When a computer is not in use, it should remain locked or off, so confidential information is secure.

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 09/22/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.