Prior Authorization Technician (Work from Home)

Job Summary

The Tech I Prior Auth takes inbound calls from providers, pharmacies, members, etc., providing professional and courteous phone assistance 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.

The Tech I will also assist with other duties as needed, including 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.

Additional 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.
• 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 assigned, for example, faxes, sorting, email boxes, CAS maintenance, etc.

Required Qualifications

• 1 year of experience in customer service or a call center environment.
• Must be able to work from home (100% remote position).
• Must have wired high-speed internet.
• Able to apply basic computer skills. Knowledge of Microsoft Office Suite (Excel and Word required; Access, Outlook, PowerPoint, Visio preferable). Keyboard skills essential.
• Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.

Preferred Qualifications

• Must be able to multitask and utilize multiple system applications simultaneously.
• 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 the confidentiality of PHI (Protected Healthcare Information).

Education

• High School Diploma or equivalent GED.

Work Schedule & Compensation

• Anticipated Weekly Hours: 40
• Time Type: Full-time
• Pay Range: $17.00 - $31.30 per hour. This range is a base pay; actual offer depends on experience, education, and other factors. Eligible for CVS Health bonus, commission, or short-term incentive program.

Benefits

CVS Health offers a comprehensive benefits package for full-time colleagues, including:

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources (based on eligibility)

Additional details are provided during the application process.

Application Window

The anticipated closing date for this opening is 04/24/2026.

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