Job Description: Take inbound calls from providers, pharmacies, members, and other callers Provide professional and courteous phone assistance through the criteria-based prior authorization process Maintain complete, timely, and accurate documentation of reviews Transfer clinical questions, escalations, and judgment calls to the pharmacist team Make outbound calls as needed Review and process prior authorizations received via fax and ePA Monitor and respond to inquiries through department mailboxes Enter prior authorization requests and verify required documentation Verify insurance coverage to determine whether prior authorization is required Inspect medical records and clinical documentation for medical necessity and appropriateness Assist with appeals for denied or rejected prior authorization requests Document patient details, medical codes, and authorization status in electronic systems Identify process inefficiencies and propose improvements Communicate with healthcare providers to obtain information, clarify documentation, and communicate decisions or requirements Stay current on industry regulations, medical coding guidelines, and prior authorization requirements Follow regulatory guidelines, company policies, and industry standards Requirements: 6 months of Customer Service/Pharmacy Technician Experience High School Diploma or equivalent GED Regular and predictable attendance Willingness to work mandatory overtime/extended work week when needed Willingness to travel when needed Ability to manage work volume by handling inbound calls/fax requests using courteous and professional behavior Compliance with departmental, company, state, and federal requirements when processing information Ability to maintain a privacy- and security-compliant home office workspace Ability to protect confidential information from being viewed or heard by others in the home Ability to sit for long periods, up to 100% Ability to talk on the phone for extended periods, 90–100% Ability to read a computer screen for extended periods, 100% Benefits: CVS Health bonus, commission or short-term incentive program in addition to base pay Medical coverage Dental coverage Vision coverage Paid time off Retirement savings options Wellness programs Other resources supporting physical, emotional, and financial well-being Home-based work environment