Prior Authorization Representative – Medicare – Work From Home

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Position Summary

As a Customer Service Rep II, Operations you will work closely with healthcare providers to process Prior Authorizations (PA) and drug benefit exception requests in a call center environment. In this role, you will play a meaningful role in ensuring member and client satisfaction. You will be performing all work in accordance with Medicare Part D guidelines. As a Rep II, Operations, youll show a high level of attention to detail, verbal and written communications skills, and the ability to problem solve in this dynamic work environment. You’ll be working various assignments that require demonstrated urgency and the ability to meet set timelines. You’ll have the opportunity to project a professional business image through phone interactions as well as internal communication. Your responsibilities will include: Working incoming cases via phone (primarily) or fax to process coverage requests from members or prescribers – Conducting outreach to patients and providers, and obtaining additional information needed to process requests – Researching and correcting any issues found in the overall process – Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed – Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations – Solving practical problems and dealing with multiple concrete variables in standardized situations – Performing basic mathematical calculations – Ensuring all cases are properly closed – Ability to interpret a variety of work instructions provided through multiple systems.

In this role, you would have flexibility to work any shift between 7:00am – 8:00pm CST (Monday – Friday) and10:00am – 2:00pm CST (Saturday).

This position is full-time and offers overtime during our business peaks. We offer a comprehensive benefits package which includes medical, dental, vision insurance as well as a wide-ranging list of supplemental benefits and discount programs. In addition to sixteen paid days off for employees, we also offer ten paid holidays.

Required Qualifications

6+ months of customer service

Pharmacy, Healthcare or related experience

Microsoft Suite Experience

Preferred Qualifications

Call center experience

PBM environment experience

Experience in a role requiring maintenance of patient confidentiality

Proficient computer skills and the ability to navigate in a Windows based environment including ability to toggle between multiple programs, ability to navigate web based systems as well as DOS based systems, and adaptable to system changes and upgrades.

Education

Verifiable High School Diploma or GED required

Pay Range

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.