Rep III Prior Authorization Appeals - CVS Health (Texas)
Job Description
Exciting opportunity to join a team of pharmacy experts within our Prior Authorization and Appeals department. The Prior Authorization and Appeals Representative III is responsible for loading and maintaining Prior Authorization and Appeal Client implementations and Client specific lettering communications within the Clinical Authorization System (CAS). The PA Admin Rep III maintains the incoming sharepoint issues and will thoroughly research and resolve all issues or inquiries in regards to PA client set up in CAS. The ideal candidate must maintain complete timely and accurate documentation of all client set up requirements, and the candidate must also provide timely and accurate information to all customers both internal and external; escalate and forward clinical issues to the PA Admin Pharmacist for assistance with resolution; work closely with PA Operations Supervisors, Pharmacists and Sr Reps to update work instructions within CAS; evaluate, size and scope all work instruction change requests; maintain the tone for how internal partners and clients view our company and services; provide the correct information at the right time; and assist with all CAS implementation needs. It is paramount that the Prior Authorization and Appeals Representative III maintain a strong understanding of all PA information, can navigate and is fluent within all claims platforms (AS400, QL), and has a thorough working knowledge of both CAS Main and CAS Admin as part of their essential functions. High levels of reliability, professionalism, customer focus, problem solving and team orientation must be exhibited to ensure success in this position.
Required Qualifications
* 6+ months experience within the CVS Caremark Prior Authorization Department or similar experience required * 6+ months experience in a complex, high impact customer service role is required
Preferred Qualifications
* National Certification (CPhT) preferred* Superior PC skills in Windows based applications * Superior CAS Admin skills * Excellent verbal and written communication skills* Superior soft skills * Able to work in a high-paced, team-oriented environment* Ability to positively deal with changes and promote a positive work environment* Advanced Math skills* Candidate must have the ability to deal with a diverse customer base in a friendly and confident manner (internal and external customers)* Flexibility to work various shifts.
Education
A verifiable High School diploma or GED is required.
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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