Pharmacy Technician - Prior Authorization - Work From Home

CVS Health

1d • $19 - $35 • Remote

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. Position Summary - Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. - Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation. - Reviews potential prior authorization denial language to ensure NCQA requirements are met. - Follows prior authorization workflow, policies, and procedures during the course of the workday. - Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions. - Maintains a balance of productivity, quality and timeliness of work. - Participates in training and continuing education as required. - Participates in team/departmental meetings as required. - Excellent attendance is a must. - Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions. - Successful pharmacy technicians will possess good written and verbal communication skills. - Hours of operation for Aetna Pharmacy Prior Authorization are between 5:00am to 7:00pm (may vary by time zone). Pharmacy Technicians work 8 hours shifts that may fall in between these hours of operations. Overnight shifts may also be available, but not guaranteed. Work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays. Part time positions are not available. Position requires the ability to work extended hours when necessary. - Rotating weekend schedule may be required. - Candidate must have their own home internet access with minimum speed of 100mbps download (internet can be hard wired with Ethernet cord). - Candidate must also have a secure workspace/office in their home. - Candidate must have high level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens). Work schedule is approximate and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays. Part time positions are not available. Position requires the ability to work extended hours when necessary. Physical Demands: Frequent speaking and listening using a headset, sitting for long periods of time working at a computer, use of hands and fingers across keyboard or mouse, using computer monitors for up to 3 hours without a break. The physical demands and work environment characteristics described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

• National Pharmacy Technician certification and applicable state Pharmacy Technician license, current and in good standing, are required and must be maintained.
• Between 1-5+ years of Pharmacy Prior Authorization processing experience.
• Ability to Multi-task and prioritize work.
• Ability to adjust based on business or department needs.
• Good organization skills
• Candidate must have their own home internet access with minimum speed of 100mbps download (internet can be hard wired with Ethernet cord).
• Candidate must also have a secure workspace/office in their home.
• Candidate must have high level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens).

Nice To Haves

• Retail or Hospital experience
• Managed Care or Medicaid experience
• AS400 experience
• Proficiency in using computerized resources and software applications
• Proficiency with Microsoft applications (Excel, Word, and Outlook)
• Knowledge in pharmacy practices, procedures, and ability to read and understand clinical information
• Working knowledge of drug dosage forms, drug strength, generic and brand name equivalent.

Responsibilities

• Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews.
• Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation.
• Reviews potential prior authorization denial language to ensure NCQA requirements are met.
• Follows prior authorization workflow, policies, and procedures during the course of the workday.
• Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions.
• Maintains a balance of productivity, quality and timeliness of work.
• Participates in training and continuing education as required.
• Participates in team/departmental meetings as required.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED