Prior Authorization Representative - Work at Home

Job Description
As a Rep II, Operations, you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for accurately setting up cases for members, review criteria for approving requests, reaching out to providers for more information to decision requests and ensuring decisions you make are correct and timely. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

Physical Requirements [ex. Sit, stand, stoop, bend and walk]

Must be able to sit in front of computer for duration of shift
Required to type on a keyboard or utilize a mouse throughout shift.

Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.16

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
1. Ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, Microsoft office applications)
2. Ability to type 30 WPM or greater
3. Excellent oral and written communication skills
4. Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment
5. Must be able to read large volume of information and determine importance
6. Receptive to constructive feedback and flexible in adapting to change
7. Flexibility with working a rotating schedule including overtime, weekends, and holidays

Work from Home position

Dedicated home workspace needed. Must be able to provide a quiet, uninterrupted work environment. Must have a workstation that is not accessible to common traffic and is secure from unintentional access.

Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet.

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
-At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service
Six months of PBM/pharmaceutical related work strongly desired

Education
- High School Diploma or GED required
Bachelors degree in related field or equivalent work experience preferred

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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