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Cvs Health Prior Authorization Remote Jobs in Minnesota

CVS Health

Senior Project Manager Meritain TPA

Plymouth, MN · On-site +1

$67K - $199K/yr

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position may sit anywhere in the US and may be either remote or hybrid depending on candidate ...

Essentia Health

Access Coordinator

Duluth, MN · On-site +1

$17.63 - $26.45/hr

Prepares and submits payer-specific prior authorizations and referrals in alignment with relevant ... Remote Shift Rotation: Day Rotation (United States of America) Shift Start Time: Shift End Time:

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Cvs Health Prior Authorization Remote information

What is a CVS Health prior authorization remote position?

A CVS Health Prior Authorization Remote position typically involves reviewing and processing prior authorization requests for prescription medications from healthcare providers and patients. Employees in this role determine whether a medication is covered under a patient's pharmacy benefit plan by evaluating clinical information and plan guidelines. Working remotely, they communicate with prescribers, pharmacies, and insurance representatives to ensure timely and accurate decisions. This job requires strong attention to detail, good communication skills, and knowledge of pharmacy benefits or healthcare processes.

What are the key skills and qualifications needed to thrive as a CVS Health prior authorization remote specialist?

To thrive as a CVS Health Prior Authorization Specialist in a remote setting, you need a strong understanding of pharmacy benefit management, healthcare regulations, and medical terminology, typically supported by a pharmacy technician certification or relevant healthcare experience. Familiarity with prior authorization software, electronic health records (EHRs), and CVS Health’s proprietary systems is commonly required. Excellent communication, attention to detail, and problem-solving skills help in effectively collaborating with providers and ensuring accurate, timely authorization decisions. These competencies are crucial for minimizing medication delays, ensuring compliance, and delivering efficient patient care.

What are the most common challenges faced by remote prior authorization specialists at CVS Health, and how can they be managed?

Remote Prior Authorization Specialists at CVS Health often encounter challenges such as managing high call volumes, staying updated on frequently changing insurance policies, and maintaining clear communication with both providers and internal teams. Effective time management, proactive learning, and utilizing CVS Health's communication platforms can help address these issues. Building strong relationships with team members through regular virtual meetings also fosters collaboration and support in a remote environment.

What is the difference between Cvs Health Prior Authorization Remote vs Cvs Health Claims Processor?

AspectCvs Health Prior Authorization RemoteCvs Health Claims Processor
CredentialsHigh school diploma or equivalent; healthcare knowledgeHigh school diploma or equivalent; healthcare or insurance knowledge
Work EnvironmentRemote, home-basedRemote or office-based, depending on location
Job FocusReviewing and approving prior authorization requests for medications and treatmentsProcessing insurance claims, verifying coverage, and coding
Industry UsageHealthcare, insuranceHealthcare, insurance

Both roles are essential in healthcare insurance, with the prior authorization remote role focusing on approving treatment requests, while the claims processor handles billing and claims verification. They share similar credentials and work environments but differ in their specific responsibilities within the insurance process.

What are the most commonly searched types of Cvs Health Prior Authorization jobs in Minnesota?

The most popular types of Cvs Health Prior Authorization jobs in Minnesota are:

What are popular job titles related to Cvs Health Prior Authorization Remote jobs in Minnesota?

For Cvs Health Prior Authorization Remote jobs in Minnesota, the most frequently searched job titles are:

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The top searched job categories for Cvs Health Prior Authorization Remote jobs in Minnesota are:

What cities in Minnesota are hiring for Cvs Health Prior Authorization Remote jobs?

Cities in Minnesota with the most Cvs Health Prior Authorization Remote job openings:

Cvs Health Prior Authorization Remote jobs near you

Prior Authorization Specialist

Minneapolis, MN • Remote

Inspire Medical Systems Inc.
Outpatient Health Care • 201 - 500 employees
Learn more about Inspire Medical Systems Inc.external

$18.75 - $25/hr

Full-time

This job post has expired 5 days ago. Applications are no longer accepted.

Job description

*Reposting - 1 of 2 Fully Remote Position*

ABOUT THIS POSITION  

We are recruiting for a Prior Authorization Specialist to join our team. In this role, you will be providing expertise in the area of prior authorization and will be responsible for implementing the Inspire Prior Authorization Program in the United States. You will be working with the Territory Managers and the prior authorization team to ensure all coding and coverage questions are answered correctly and concisely.

OPPORTUNITIES YOU WILL HAVE IN THIS ROLE  

  • Support Inspire's Prior Authorization Program, including:
    • Entering and managing patient information in database
    • Assisting with patient intake and verifying of insurance coverage
    • Calling insurances to obtain the status of Prior authorization requests
    • Working with patients and sites to pursue authorization success.
  • Assist in tracking and monitoring progress of prior authorization requests, along with all related appeals through to EMR.
  • Participate in updating the packet of materials and best practices methods to support the prior authorization and appeals processes, including External Medical Review, (EMR) for upper airway stimulation.
  • Seek continuous process improvement to increase success rates and reduce time to success.
  • Implement Inspire's Prior Authorization Program, including:
    • Training sites on program requirements
    • Entering and managing patient information in database
    • Completing prior authorization requests
    • Providing guidance to participating sites on all levels of appeals including EMR
    • Working directly with the patient to pursue EMR success.
  • Provide general coding information to physician customers upon request.
  • Work in conjunction with manager and staff to execute action plans and objectives to support internal/external clients.

QUALITY SYSTEM RESPONSIBILITIES

  • Document product and therapy related field reports within the prescribed timelines and provide any necessary documents required to complete the investigation. Provide follow-up reporting as needed.
  • Complete training requirements and competency confirmations as required for this position within the required timeline.
  • Comply with applicable quality system procedures/policies and make suggestions for continuous process improvement.

WHAT YOU CAN BRING TO OUR GREAT TEAM

Required: 

  • 2+ years of related work experience in reimbursement
  • Demonstrated knowledge of reimbursement compliance requirements and a maintaining a high level of personal integrity to promote a compliant reimbursement environment
  • Ability to read, interpret and appropriately respond to payer requirements relating to prior authorization
  • Ability to read, interpret and summarize clinical and cost literature
  • Excellent written and oral communication skills
  • Proficient in Microsoft Office applications, including Word, PowerPoint, Excel
  • High attention to detail and strong team attitude
  • Comfortable in a small, dynamic company environment with frequent changes in direction

Preferred: 

  • Bachelor's degree
  • Medical device experience

#LI-Remote

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