Authorization Team Lead

CVS Health•Work At Home-Virginia, VA

2d•Onsite

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Requirements

Minimum 1 year experience working in a customer service or call center environment.
Experience verifying benefits with insurance companies
Data entry experience.
Working knowledge in Microsoft Office, specifically Outlook and Word.
Verifiable High School Diploma or GED is required.

Nice To Haves

Home infusion or durable medical equipment (DME) experience.
Experience work in a healthcare environment.
Experience working with healthcare ins

Responsibilities

Leads and supports a team of Authorization Specialists responsible for obtaining, tracking, and maintaining insurance authorizations for medical services and procedures.
Serves as a primary point of contact for patients regarding authorization status, insurance requirements, and coverage-related questions, ensuring accurate and timely communication.
Reviews patient records and insurance information to determine authorization needs, verifies benefits, and ensures compliance with payer guidelines and regulatory requirements.
Coordinates with insurance carriers, physician offices, and clinical staff to submit prior authorization requests, appeals, and supporting documentation.
Monitors authorization workflows and daily productivity to ensure all pending, approved, denied, or expiring authorizations are followed up on and resolved within required timeframes.
Identifies denied or delayed authorizations, investigates root causes, and works proactively to resolve issues to prevent delays in patient care or revenue loss.
Maintains accurate documentation and updates authorization status in the electronic health record (EHR) and billing systems by close of business (COB).
Acts as a liaison between patients, providers, and insurance companies to facilitate clear communication and continuity of care.
Assists leadership with onboarding, training, and ongoing development of Authorization team members, including payer-specific rules and best practices.
Provides coaching, feedback, and performance guidance to junior Authorization staff through team meetings and on-the-job training, documenting strengths and improvement opportunities.
Supports department leadership with quality audits, process improvements, and adherence to compliance, payer, and organizational policies.