Prior Authorization Representative - Medicare - Work From Home

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

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, you'll 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:

$17.00 - $28.45

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

We anticipate the application window for this opening will close on: 06/20/2024

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.