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CVS Health Prior Authorization Representative-Medicare-Work From Home in Texas

Job Description

As a Clinical Representative, you will work closely with healthcare providers to process Prior Authorizations (PA) and drug benefit exception requests in a call center environment. In the Clinical Representative 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. In this role, you would have flexibility to work any shift between 7:00am - 10:00pm (Monday - Friday) and1000-pm(Saturday). As a Clinical Representative, 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 mediums - Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards - Schedule flexibility including rotations through Nights, Saturdays and minimal Holiday Coverage

Required Qualifications

6+ months of customer service, pharmacy or related experience in a complex service industry.

Preferred Qualifications

-Call center experience Pharmacy or PBM environment preferred highly.- 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.


Verifiable High School Diploma or GED required

Business Overview

At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.