Pharmacy Technician - Prior Authorization - Work From Home

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Briefly describe the primary functions of the position (i.e., the key areas of responsibilities and key interactions, overall decision-making authority, budget impact, strategic and operational impact, business complexity).  

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 Auths received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.

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%

-    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).

- 6+ months of Customer Service/Pharmacy Technician Experience

- Regular and predictable attendance
- Colleague will be required to work mandatory overtime/extended work week when needed
- Colleague will be required to travel 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.

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%)
4.  Light lifting of less than 10 lbs (5%)

WORK ENVIRONMENT:

Work in a climate-controlled, smoke-free internal environment; work to be performed regularly in a CVS Health location or from an approved work-from-home location.

The typical pay range for this role is:

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. 
 

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.