Role Description The Tech I Prior Auth takes in-bound calls from providers, pharmacies, members, etc., providing professional and courteous phone assistance to all callers through the criteria-based prior authorization process. Maintains complete, timely, and accurate documentation of reviews and transfers all clinical questions, escalations, and judgment calls to the pharmacist team. The Tech I will also assist with other duties as needed, including but not limited to: - Outbound calls - Reviewing and processing Prior Auths received via fax and ePA - Monitoring and responding to inquiries via department mailboxes - Other duties as assigned by the leadership team Additional responsibilities include: - Entering prior authorization requests submitted by healthcare providers, ensuring all required documentation is complete and accurate - Verifying insurance coverage to determine if prior authorization is required for specific medical procedures, treatments, or medications - Inspecting medical records and clinical documentation to assess the medical necessity and appropriateness of the requested services or treatments - Assisting in the preparation and submission of appeals for denied or rejected prior authorization requests, including gathering necessary supporting documentation - Documenting relevant information into electronic systems, including patient details, medical codes, and prior authorization status - Communicating with team members and supervisors to identify process inefficiencies and propose solutions to streamline prior authorization operations - Communicating with healthcare providers to obtain additional information, clarify documentation, and communicate prior authorization decisions or requirements - Maintaining awareness of updated industry regulations, medical coding guidelines, and changes in prior authorization requirements by participating in training sessions and knowledge-sharing activities - Ensuring adherence to regulatory guidelines, company policies, and industry standards during the prior authorization process Qualifications - 6 plus months of Customer Service/Pharmacy Technician Experience - Able to apply basic computer skills - Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable - Keyboard skills essential - Regular and predictable attendance - Colleague will be required to work mandatory overtime/extended work week when needed - Colleague will be required to travel when needed - Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards - Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers Preferred Qualifications - Must be able to multitask and utilize multiple system applications simultaneously - Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols - Must be able to absorb 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 base (internal and external) in a friendly and confident manner - Ability to maintain confidentiality of PHI (Protected Healthcare Information) Education - High School Diploma or equivalent GED Anticipated Weekly Hours - 40 Time Type - Full time Pay Range The typical pay range for this role is: $17.00 - $28.46. 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. Benefits This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include: - Medical, dental, and vision coverage - Paid time off - Retirement savings options - Wellness programs - Other resources, based on eligibility Additional details about available benefits are provided during the application process and on Benefits Moments. Application Window We anticipate the application window for this opening will close on: 06/19/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.