Prior Authorization Representative

Prior Authorization RepresentativeAt CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.The Prior Authorization colleague 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. You will maintain complete, timely, and accurate documentation of reviews. As a Prior Authorization Representative you will make the determination if a complex request should be transferred to a pharmacist for assistance. You will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Authorizations received via fax & ePA, and other duties as assigned by the leadership team.Must have open availability from 8:00am - 8:00pm CST.Nationwide work from home.Primary Duties And Responsibilities: Effectively manage work volume by handling inbound calls/fax/ePA 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. Communicate with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc). Identify and elevate clinical inquiries to the pharmacist team as appropriate. Other duties as assigned, for example faxes, sorting, ePA, etc.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, and protocols is preferred. 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).Required Qualifications: 6+ months of Customer Service experience, call center environment experience preferred. Regular and predictable attendance. Colleague will be required to work mandatory overtime/extended work week 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. Regularly in a CVS Health location or from an approved work-from-home location.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):1. Employee has a workspace that ensures compliance with CVS Health privacy and security policies and procedures.2. Information on computer screen must not be accessible or viewable by others.3. Telephone conversations involving confidential information must not be audible to others present in the home.4. Any CVS equipment or documents may not be accessible by others inside or outside of business hours.5. When a computer is not in use, it should remain locked or off, so confidential information is secure.Education:Verifiable High School Diploma or GED requiredAnticipated Weekly Hours 40Time Type Full timePay Range The typical pay range for this role is: $17.00 - $34.15This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on 12/05/2025.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.