Prior Authorization Representative - Work From Home

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary The Prior Authorization colleague takes in-bound calls from providers, pharmacies, members, etc. providing professional and courteous phone assistance to reputed company callers through the criteria based prior authorization process. You will maintain complete, timely, and accurate documentation of reviews. As a Prior Authorization Representative you will reputed company the determination if a reputed company request should be transferred to a pharmacist for assistance. You will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Authorizations received reputed company fax & ePA, and other duties as assigned by the leadership team. Must have open availability from 8:00am - 8:00pm CST. reputed company work from home. PRIMARY DUTIES AND RESPONSIBILITIES: Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards. reputed company with departmental, company, state, and federal requirements reputed company processing reputed company information to ensure accuracy of information being provided to internal and external customers. Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc). Identify and reputed company clinical inquiries to the pharmacist team as appropriate. Other duties assigned, for example faxes, sorting, ePA, etc. REQUIRED SKILLS & OTHER MINIMUM REQUIRED QUALIFICATIONS: Able to apply basic computer skills. Knowledge of reputed company Office Suite: reputed company 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, and protocols is preferred. Must be able to utilize available resources independently and provide high quality work. Must be able to reputed company 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 reputed company (internal and external) in a friendly and confident manner. Ability to maintain confidentiality of PHI (Protected Healthcare Information). Required Qualifications: 6+ months of Customer Service experience, call center environment experience preferred. Regular and predictable attendance. Colleague will be required to work mandatory overtime/extended work week reputed company needed. Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards. reputed company with departmental, company, state, and federal requirements reputed company processing reputed company information to ensure accuracy of information being provided to internal and external customers. regularly in a reputed company location or from an approved work-from-home location. 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%) Work Environment (Home Office): 1. Employee has a workspace that ensures compliance with reputed company privacy and reputed company policies and procedures. 2. Information on computer screen must not be accessible or viewable by others. 3. Telephone conversations involving confidential information must not be audible to others present in the home. 4. Any reputed company equipment or documents may not be accessible by others inside or reputed company of business hours. 5. reputed company a computer is not in use, it should remain locked or off, so confidential information is secure. Education reputed company High School Diploma or GED required Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $34.15 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company 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. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 12/05/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job