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Cvs Health Prior Authorization Remote Jobs in Utah

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BCBA (Full-Time, Remote)

Saint George, UT · Remote

$75K - $105K/yr

We are growing at a healthy, exciting pace and are looking for employees who are passionate about ... Prior experience in a remote role is preferred. * Willingness to travel to our center on a ...

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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.

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

Cvs Health Prior Authorization Remote jobs near you

Prior Authorization Representative I

Salt Lake City, UT • On-site, Remote

University of Utah Health
Colleges, Universities, and Professional Schools • 10K+ employees

7.2

Company rating: 7.2 out of 10

Based on 159 frontline employees who took The Breakroom Quiz

385th of 623 rated colleges and universities

People enjoy working here

Good employer

Recommended by students

Learn more about University of Utah Healthexternal

$16.50 - $21/hr

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Overview
This position is primarily remote work, but candidate must reside within the state of Utah for this one.
Top candidates will also have some prior working experience in Prior Authorizations.
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA
This position is responsible to secure outpatient accounts by performing insurance verification, obtaining benefit information, calculating patient estimates, and obtaining prior authorization before services are rendered. This position works with physicians, nurses, clinic managers, and financial advocates to resolve issues that arise during the prior authorizations process. This position is not responsible for providing care to patients.
Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.
Responsibilities
Essential Functions
  • Verifies insurance eligibility, benefits, network status, and creates pre-service liability estimate.
  • Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request.
  • Secures prior authorizations for outpatient imaging and in office scheduled services.
  • Acts as a liaison between the payer and clinic schedulers/medical support staff.
  • Follows up on delayed or denied authorization requests and escalates for resolution.
  • Creates detailed documentation and maintains/stores the authorization paper trail.
  • May work to resolve claims denials related to the prior authorization.
Knowledge / Skills / Abilities
  • Basic knowledge of accounting, word processing, and spreadsheets.
  • Demonstrated critical thinking and ability to analyze information and problem solve.
  • Demonstrated professional verbal/written communication skills.
  • Ability to work independently within a team setting.
  • Ability to adapt to a dynamic work environment.
  • Demonstrated ability to prioritize and manage a large workload in stressful situations.
  • Ability to multitask.
  • Familiarity with human anatomy and medical terminology.
  • Demonstrated ability to complete work with a high level of detail and accuracy.
  • Ability to meet process time standards.
  • Ability to provide professional and courteous service in all interactions with internal and external customers.
  • Ability to navigate through various hospital software applications, including Epic ADT/Prelude, Cadence, Epicare, Referrals and Auth/Cert applications.
  • Ability to navigate and maneuver through multiple web sites.

Qualifications
Required
  • Two years of experience in a health care financial setting, or the equivalency.

Qualifications (Preferred)
Preferred
  • Previous experience with medical insurance and prior-authorizations.
  • ICD/CPT coding experience.
  • Outpatient or Radiology prior authorizations experience.
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
  • This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull, or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements
Listening, Sitting, Speaking
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About University of Utah

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The University of Utah is the state’s flagship institution of higher education, with 18 schools and colleges, more than 100 undergraduate majors and graduate programs, and an enrollment of more than 38,000 students. It is a member of the Association of American Universities—an invitation-only, prestigious group of 71 leading research institutions. The U is advancing a new national model for higher education that delivers societal impact through education, research, health care, and community service, while making social, economic, and cultural contributions that improve lives across Utah and around the world.

Industry

Colleges, universities, and professional schools

Company size

10,000+ Employees

Headquarters location

Salt Lake City, UT, US

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