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Cvs Prior Authorization Remote Jobs in Texas (NOW HIRING)

ConnectMed360

Oncology Case Manager

Houston, TX · On-site +1

$60K/yr

This position is Full-Time , Remote , working Monday - Friday starting out 9:30am to 6:00pm then ... Support the facilitation of prior authorization and appeal processes by gathering necessary ...

TQA

... prior authorization, backed by TQA's partnerships with Microsoft, UiPath, and ServiceNow. You're ... Department Sales Locations US Remote status Fully Remote

Valeris

Executive Case Manager (Remote)

Austin, TX · Remote

$19.75 - $25.50/hr

Proactively communicates needs for reverification of prior authorization or re-enrollment. * Identifies and reports adverse events, product complaints, special situation reports and/or medical ...

PharmaCord LLC

Executive Case Manager (Remote)

Austin, TX · On-site +1

$19.75 - $25.50/hr

Proactively communicates needs for reverification of prior authorization or re-enrollment. * Identifies and reports adverse events, product complaints, special situation reports and/or medical ...

TEKsystems

Revenue Cycle Manager

Dallas, TX · Remote

$90K - $125K/yr

... Prior Authorization approval process and oversees the hiring, training, and compliance of the ... remote position. Application Deadline This position is anticipated to close on Sep 4, 2026. About ...

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Cvs Prior Authorization Remote information

What is a CVS Prior Authorization remote?

A CVS Prior Authorization Remote job involves reviewing and processing medication prior authorization requests for CVS Health from a remote location. Employees in this role evaluate whether prescribed medications meet insurance requirements and communicate with healthcare providers or patients as needed. The job typically requires strong attention to detail, excellent communication skills, and a background in pharmacy or healthcare. Working remotely allows for flexibility while ensuring timely and accurate authorization decisions.

What are the primary responsibilities of a CVS Prior Authorization Specialist working remotely, and how do they collaborate with other healthcare professionals?

As a remote CVS Prior Authorization Specialist, your main duties involve reviewing and processing prior authorization requests for prescription medications, ensuring compliance with clinical guidelines and insurance requirements. You will regularly communicate with physicians, pharmacists, and insurance representatives to gather necessary information and clarify any discrepancies. Collaboration is typically conducted via secure digital platforms, phone, or email. The role requires strong attention to detail, timely decision-making, and the ability to work independently while maintaining high productivity standards in a virtual team environment.

What are the key skills and qualifications needed to thrive as a CVS Prior Authorization Specialist remote, and why are they important?

To thrive as a CVS Prior Authorization Specialist (Remote), you need a solid understanding of pharmacy benefits, insurance processes, and medical terminology, often supported by a pharmacy technician certification or relevant experience. Familiarity with prior authorization systems, electronic medical records (EMRs), and CVS-specific platforms is typically required. Strong attention to detail, excellent communication, and problem-solving abilities are crucial soft skills for efficiently handling patient and provider inquiries. These competencies are essential for ensuring accurate and timely medication approvals, which directly impact patient care and satisfaction.

What is the difference between Cvs Prior Authorization Remote vs Cvs Pharmacy Technician?

AspectCvs Prior Authorization RemoteCvs Pharmacy Technician
Required CredentialsCertification in healthcare or pharmacy-related fields, knowledge of insurance and prior authorization processesState pharmacy technician license, certification (e.g., PTCB), knowledge of pharmacy operations
Work EnvironmentRemote, administrative setting focused on insurance and authorization tasksIn-store or pharmacy setting, assisting pharmacists and customers
Employer & Industry UsageHealthcare and pharmacy companies, insurance providersRetail pharmacies, healthcare providers
Common Search & Comparison IntentUnderstanding remote administrative roles in pharmacyUnderstanding pharmacy technician roles and responsibilities

While Cvs Prior Authorization Remote involves handling insurance approvals remotely, Cvs Pharmacy Technicians work directly in pharmacies assisting with medication dispensing. Both roles require pharmacy-related knowledge but differ in work environment and specific credentials.

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

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

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

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

What job categories do people searching Cvs Prior Authorization Remote jobs in Texas look for?

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

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

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

Cvs Prior Authorization Remote jobs near you
Infographic showing various Cvs Prior Authorization Remote job openings in Texas as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Member and Provider Services Specialist

Harbor Health

Austin, TX • On-site, Remote

$17 - $21/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 3 days ago

New

Key responsibilities

  • Support members and providers by addressing inquiries related to benefits, coverage, claims, billing, referrals, and prior authorizations.

  • Verify member eligibility and benefits, and assist with enrollment, portal registration, and digital self-service tools.

  • Research and resolve claims and billing issues, and document all interactions while maintaining compliance and confidentiality.

Job description

Description
Harbor Health
Remote - Texas Based
POSITION OVERVIEW
Harbor Health is seeking a compassionate, highly skilled, and solution-oriented Member & Provider Services Specialist to join our innovative, integrated healthcare organization. As a key ambassador of the Harbor Health experience, you will serve as a trusted resource for members, providers, and business partners by delivering exceptional service across both our health plan and medical group. You will support a broad spectrum of member and provider inquiries throughout the healthcare journey - including educating members on benefits and coverage, resolving claims and billing questions, supporting enrollment and eligibility, assisting with referrals and prior authorizations, and managing complaints, grievances, and appeals in accordance with regulatory requirements. This role is central to delivering Harbor Health's commitment to a unified, frictionless, member-centered experience that aligns with our mission of transforming healthcare through our payvider model.
POSITION DUTIES & RESPONSIBILITIES
Member Services
  • Serve as the primary point of contact for members through phone, email, chat, and other communication channels
  • Educate members regarding health plan benefits, eligibility, covered services, exclusions, deductibles, copays, coinsurance, and out-of-pocket responsibilities
  • Assist members with provider selection, appointment scheduling, referrals, and navigation throughout the healthcare system
  • Guide members through enrollment, eligibility updates, PCP changes, and Marketplace or Large Group insurance questions
  • Assist members with portal registration and digital self-service tools
  • Promote first-call resolution while delivering a personalized, empathetic member experience

Provider Services
  • Serve as a primary resource for participating and non-participating providers
  • Support provider inquiries regarding member eligibility, benefits, claim status, payment, referrals, prior authorizations, and network participation
  • Educate providers on Provider Relations and Network Management processes to resolve provider concerns efficiently

Eligibility & Benefits
  • Verify member eligibility and benefits using Athena, payer portals, and internal systems
  • Confirm benefit coverage, network participation, plan limitations (HMO, PPO, POS, Marketplace, etc.), and applicable member financial responsibility
  • Educate members regarding referral requirements and available in-network resources to improve access and reduce out-of-pocket costs
  • Resolve eligibility discrepancies by working directly with health plans or guiding members through corrective actions

Claims & Billing Support
  • Research and resolve claims inquiries for members and providers
  • Explain claim adjudication, payment determinations, denials, coordination of benefits, and reimbursement processes
  • Assist with billing questions, patient balances, payment options, and payment plan information
  • Escalate complex financial or reimbursement issues to Claims or Billing teams while maintaining ownership of the member experience

Prior Authorization & Referrals
  • Educate members and providers regarding prior authorization requirements, referral processes, and documentation needs
  • Explain authorization status, next steps, and expected turnaround times
  • Coordinate with Utilization Management and Clinical Operations to facilitate timely resolution

Appeals, Grievances & Complaints
  • Intake and document member and provider complaints, grievances, and appeals accurately and completely
  • Ensure all required documentation is collected to support investigations and regulatory review
  • Maintain compliance with CMS, TDI, NCQA, HIPAA, and Harbor Health policies
  • Escalate potential compliance, quality of care, patient safety, or regulatory issues appropriately

Network Access & Care Navigation
  • Identify access-to-care concerns and potential network adequacy issues
  • Assist members in locating participating providers and obtaining timely appointments
  • Escalate network access barriers in accordance with regulatory access standards
  • Support members through complex care coordination and navigation needs

Documentation & Communication
  • Manage high-volume inbound and outbound phone calls, emails, and written correspondence
  • Accurately document all member and provider interactions in applicable systems
  • Maintain detailed case notes while ensuring confidentiality of Protected Health Information (PHI)
  • Follow approved communication standards while personalizing interactions to meet individual member needs

Operational Excellence
  • Meet established quality, productivity, attendance, and service level expectations
  • Demonstrate flexibility in a rapidly evolving healthcare environment
  • Participate in ongoing training, coaching, and professional development
  • Support continuous improvement initiatives designed to enhance the member and provider experience

DESIRED PROFESSIONAL SKILLS & EXPERIENCE
  • High School Diploma or equivalent; Associate's or Bachelor's degree preferred
  • 2+ years of experience in a healthcare contact center, member services, or provider services role
  • Working knowledge of health insurance operations including eligibility, benefits, claims, prior authorizations, referrals, and appeals/grievances processes
  • Familiarity with CMS, TDI, NCQA, and HIPAA compliance requirements as they relate to member and provider services
  • Proficiency with EMR and payer portal systems; experience with Athena a plus
  • Exceptional customer service, communication, and active listening skills
  • Strong analytical and problem-solving skills with the ability to navigate multiple systems simultaneously
  • Ability to manage high call and case volume while maintaining accuracy and compassion
  • Demonstrated ability to work collaboratively across cross-functional teams
  • Strong attention to detail and documentation discipline
  • Preferred: Experience in a payvider, integrated delivery system, or health plan environment
  • Preferred: Familiarity with Medicare Advantage, Medicaid, ACA Marketplace, or employer group insurance products
  • Preferred: Experience handling appeals, grievances, or regulatory complaint processes
  • Preferred: Knowledge of medical terminology, CPT/ICD-10 coding, or claims adjudication
  • Preferred: Bilingual in English/Spanish

WHAT WE OFFER
  • Competitive salary and incentives
  • Generous PTO
  • 10 paid holidays
  • Medical, Dental, and Vision Insurance
  • 401(k) Investment Plan
  • Company Equity
  • Professional development and growth opportunities

COMPANY OVERVIEW
At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!
EQUAL EMPLOYMENT OPPORTUNITY STATEMENT
Harbor Health is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other status protected by applicable federal, state, or local law. All employment decisions are based on qualifications, merit, and business need.

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