Role Description
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 judgment calls to the pharmacist team.
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Assist with outbound calls, reviewing and processing Prior Auths received via fax and ePA.
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Monitor and respond to inquiries via department mailboxes.
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Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards.
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Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
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Communicate with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc.).
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Identify and elevate clinical inquiries to the pharmacist team as appropriate.
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Other duties assigned, for example, faxes, sorting, email boxes, CAS maintenance, etc.
Qualifications
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6 months experience in customer service or call center environment.
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Must be able to work from home; this is a 100% work from home position.
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Have wired high-speed internet.
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Able to apply basic computer skills; knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable.
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Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.
Requirements
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Must be able to multitask and utilize multiple system applications simultaneously.
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Must be able to utilize available resources independently and provide high-quality work.
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Must be able to absorb presented information, display motivation, seek development, and problem solve.
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Ability to adapt and change with workflow and shifting priorities.
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Must possess excellent written, verbal, grammar, and listening communication skills.
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Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.
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Ability to maintain confidentiality of PHI (Protected Healthcare Information).
Education
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High School Diploma or equivalent GED.
Pay Range
The typical pay range for this role is: $17.00 - $31.30. 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.
Benefits
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Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
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Medical, dental, and vision coverage.
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Paid time off.
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Retirement savings options.
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Wellness programs and other resources, based on eligibility.
