Experienced Senior Representative for Authorization and Patient Access – Home Infusion and Specialty Pharmacy Services

Introduction to CVS Health and Our Mission

At CVS Health, we are driven by a singular purpose: to bring our heart to every moment of your health. This guiding principle underscores our commitment to delivering human-centric healthcare in a rapidly evolving world. Our brand, with heart at its core, sends a powerful message that how we deliver our services is just as important as what we deliver. We believe in empowering our employees through our Heart At Work Behaviors, which support our purpose and foster a culture of innovation, personalization, and affordability in healthcare.

About the Role: Senior Representative for Authorization

We are seeking a highly motivated and experienced healthcare professional to join our national team as a Senior Representative for Authorization. This rewarding opportunity involves working closely with our Patient Intake Coordinators and Insurance Providers to secure authorizations for In-Home IV Therapy for Coram/CVS specialty infusion patients. As a Senior Authorization Representative, you will play a pivotal role in creating a positive experience for our patients by obtaining authorizations for both new and existing patients, ensuring timely prescription orders, and demonstrating exceptional customer service to our referrals, insurance carriers, and patients.

Key Responsibilities:

• Obtain authorizations from insurance carriers for In-Home IV Therapy and other specialty infusion services.
• Work collaboratively with Patient Intake Coordinators to ensure seamless patient onboarding and authorization processes.
• Communicate effectively with insurance providers, patients, and internal stakeholders to resolve authorization issues and ensure timely prescription fulfillment.
• Demonstrate a thorough understanding of insurance concepts, including drug cards, major medical benefits, per diem coverage, government programs, and patient assistance programs.
• Analyze and resolve complex authorization issues, leveraging problem-solving skills and attention to detail.
• Maintain accurate and detailed records of authorization requests, outcomes, and follow-up activities.
• Participate in ongoing training and education to stay current with changing insurance regulations, policies, and procedures.

Essential Qualifications:

To be successful in this role, you will need:

• Minimum 1 year of experience working in a healthcare environment, preferably in a role involving prior authorizations or patient access.
• Previous experience working with prior authorizations, insurance verification, or medical billing procedures.
• Strong analytical and problem-solving skills, with the ability to multitask and pay close attention to detail.
• Experience working with Microsoft Office, specifically Excel, Word, and Outlook.
• High School Diploma or GED required; associate's or bachelor's degree in a healthcare-related field preferred.

Preferred Qualifications:

While not required, the following qualifications are highly desirable:

• Knowledge of Medicare, Medicaid, and Third Party Vendors.
• Pharmacy, PBM, or Specialty Pharmacy experience.
• Experience working with healthcare insurance verification and medical billing procedures.
• Familiarity with electronic health records (EHRs) and practice management systems.

Skills and Competencies:

To excel in this role, you will need to possess:

• Excellent communication and interpersonal skills, with the ability to build strong relationships with patients, providers, and insurance carriers.
• Strong analytical and problem-solving skills, with the ability to navigate complex authorization issues and insurance regulations.
• Ability to work in a fast-paced environment, prioritizing multiple tasks and meeting deadlines.
• Proficiency in Microsoft Office, with the ability to learn and adapt to new software systems.
• A strong commitment to customer service, patient satisfaction, and quality outcomes.

Career Growth Opportunities and Learning Benefits:

At CVS Health, we are committed to supporting the growth and development of our employees. As a Senior Authorization Representative, you will have access to:

• Ongoing training and education to stay current with changing insurance regulations and industry trends.
• Opportunities for career advancement and professional growth within the company.
• A comprehensive benefits package, including medical, dental, and vision coverage, 401(k) retirement savings plan, and employee stock purchase plan.
• A dynamic and supportive work environment, with a team of experienced professionals who are passionate about delivering exceptional patient care.

Work Environment and Company Culture:

Our company culture is built on a foundation of heart, empathy, and compassion. We believe in creating a work environment that is inclusive, supportive, and empowering, where every employee can thrive and grow. As a Senior Authorization Representative, you will be part of a national team that is dedicated to delivering exceptional patient care and making a positive impact in the lives of our patients and communities.

Compensation, Perks, and Benefits:

We offer a competitive salary range of $18.50 - $35.29 per hour, depending on experience and location. In addition to your base salary, you will be eligible for a CVS Health bonus, commission, or short-term incentive program. Our comprehensive benefits package includes:

• Medical, dental, and vision coverage.
• 401(k) retirement savings plan and employee stock purchase plan.
• Paid time off (PTO) and vacation pay.
• Paid holidays throughout the calendar year.
• Well-being programs, education assistance, and free development courses.
• CVS store discount and discount programs with participating partners.

Conclusion:

If you are a motivated and experienced healthcare professional who is passionate about delivering exceptional patient care, we encourage you to apply for this exciting opportunity. As a Senior Authorization Representative at CVS Health, you will be part of a dynamic team that is dedicated to making a positive impact in the lives of our patients and communities. Don't miss out on this chance to join our team and start your future with CVS Health. Apply now!