Prior Authorization Representative (Work from Home)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This position is for a Clinical Pharmacist working in the Prior Authorization team. - Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. - Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. - One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. - Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. - Establishes and maintains communicat

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary - Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. - Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation. - Reviews potential prior authorization denial language to ensure NCQA requirements are met. - Follows prior authorization workflow, policies, and procedures during the course of the workday. - Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions. - Maintains a balance of productivity, quality and timeliness of work. - Participates in training and continuing education as required. - Participates in team/departmental meetings as required. - Excellent attendance is a must. - Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions. - Successful pharmacy technicians will possess good written and verbal communication

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Technician I is the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base. The Tech I will make the determination if a complex request should be transferred to a pharmacist for assistance. Additionally, the Tech I is responsible for maintaining complete, timely, and accurate documentation of all approvals and denials. In order to be successful in this role you will need proficiency pronouncing drug names and diagnosis and recognizing medical terminology. As well as navigating multiple software systems to document conversations and outcomes, which require keyboarding skills. This position requires schedule flexibility including rotations through nights, weekend and holiday coverage. Required Qualifications - 1 year experience in customer service or call center environment - Must be able to work from home - Have high speed internet Preferred Qualifications - Previous experience in pharmacy or healthcare industry. - Associate's or Bachelor's Degree. Pharmacy Technician License Education High School Diploma or equivalent GED Anticipated Weekly Hours 40<p style="text

At Vanta, our mission is to help businesses earn and prove trust. We believe that security should be monitored and verified continuously, and we empower companies to practice better security and prove it with ease. Vanta has a kind and talented team, and while some have prior security experience, many have been successful at Vanta without it. Our Software Engineers build and own high-value products for our customers and the infrastructure that lets our business scale. Vanta's team and technology surface are growing quickly, and it's essential that we invest in the right abstractions and systems to scale with our business. As a Software Engineer, you'll build and own full-stack features and platform primitives across our stack, work closely with the teams and partners who depend on what you ship, and grow into broader technical ownership. Your work will directly accelerate Vanta's growth. Our business has found incredible product-market fit and has monetized effectively since the day we signed our first customer. We're growing at a blistering pace, which presents career-defining opportunities for engineers to accelerate their growth and to contribute to a rapidly-scaling company. Visit our Vanta Engineering Blog to learn more about what our team is working on! The Integrations Platform team within Vanta Government Cloud mission is to power the world's largest trust automation ecosystem, enabling any person or agent to build, connect, and automate trust seamlessly. Federal compliance is going through its biggest shift in a decade and this team builds the integration platform underneath Vanta Government Cloud that turns federal frameworks into automated, continuously monitored product experiences. This is a builder role: you'll turn federal control requirements into the platform primitives and integrations that make continuous authorization real. We own Vanta's integration ecosystem within the US Government Cloud, which currently includes a growing set of integrations

We believe that the way people interact with their finances will drastically improve in the next few years. We’re dedicated to empowering this transformation by building the tools and experiences that thousands of developers use to create their own products. Plaid powers the tools millions of people rely on to live a healthier financial life. We work with thousands of companies like Venmo, SoFi, several of the Fortune 500, and many of the largest banks to make it easy for people to connect their financial accounts to the apps and services they want to use. Plaid’s network covers 12,000 financial institutions across the US, Canada, UK and Europe. Founded in 2013, the company is headquartered in San Francisco with offices in New York, Washington D.C., London and Amsterdam. Security Engineering is the engineering function inside the Plaid security org that focuses on developing the industry-leading security systems and infrastructure. Security Engineering owns most of Plaid’s security-related infrastructure: secure data storage, key management systems, internal identity platform, internal authentication systems, internal permission management, and internal authorization service. We develop solutions across data encryption, key management, access control, and data loss prevention to protect sensitive consumer data. We believe in the Zero Trust security model and are always looking for ways to improve our authentication and access control platforms. About the role: You will develop security capabilities to secure Plaid infrastructure and sensitive data access. You will lead the team’s strategic planning in collaboration with the manager and other senior engineers. You will own, maintain, and build Plaid’s security infrastructure and services like IAM Gateway, Key Management System and Network Firewall. You will consult with product engineers to ensure Plaid services meet security standards. You will help educate and support other engineering teams to improve security in

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary As the Senior Lead Coordinator you will be responsible for implementing and maintaining comprehensive billing review processes. You will identify and quantify trends/issues and effectively communicate/report them to the appropriate members of the management team and payer business partners along with the potential impact. You will assist leadership in building and maintaining a high performing highly engaged team. In this role you will also provide excellent mentorship and support to your colleagues as well as design and implement training classes. The key responsibilities of the Medical Revenue Cycle Senior Lead Coordinator are: Review and analyze patient profiles, benefits, and prior authorizations to identify potential issues affecting clean claims. Collaborate with clinical and administrative teams to ensure accurate documentation is maintained and available for claims processing. Monitor claims submissions and follow up on pending claims to expedite resolution and payment. Identify trends in claims denials and develop strategies for improvement. Conduct training sessions for staff on best practices for claims submissions and compliance. Maintain up-to-date knowledge of insurance policies, regulations, and healthcare trends that impact claims