Prior Authorization and Benefits Specialist
4 weeks ago
Job Title: Prior Authorization and Benefits Specialist
Pay: $17.50 an hr | Bi-weekly
Job Type: Remote
Shift Options:
- Hours: Mon-Fri 7AM-8:30PM CST. Training hours: Mon-Fri 8AM-4:30PM CST for 4 weeks.
Prior Authorization and Benefits Specialist Overview:
- The Commercial PA Representative I will work closely with providers to process prior authorization PA and drug benefit exception requests on behalf of CVS Health as the client and in accordance with Medicare Part D CMS Regulations.
- Must apply information [provided through multiple channels] to the plan criteria defined through work instruction.
- Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
- Responsible for research and correction of any issues found in the overall process.
- Phone assistance is required to initiate and/or resolve coverage requests.
- Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed.
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