Job Description CIC support staff is responsible for assisting in the resolution of Patient Specific Therapeutic Interchange (PSTI) or rejected clinical claims management (Prior Authorizations and Covered Alternative Recommendations)
Work rejected real-time claims for all pharmacies supported by the CIC under the direction of the CIC pharmacists. o Make phone calls to insurance plans. o Work with local pharmacies to meet run times and ensure timely dispensing of medications. o Work with facility staff to gather pertinent information needed to secure overrides/prior authorizations.
Reconcile facility responses via online communication portal.
Initiates Prior Authorization and obtain pertinent information from facility/prescribers as directed by a CIC pharmacist or Clinical Specialist.
Call insurance plans to follow-up on submitted prior authorizations in timely manner
Communicate with CIC and local pharmacy staff regarding the outcomes of the prior authorization requests and in the case of prior authorization denials work with pertinent staff to take the appropriate next steps in the resolution of the rejection
Communicate any changes in prior authorization criteria or issues related with various insurance plans and processors to management team.
Scan and send new or authorized orders to the appropriate destination
Track all claim detail, activity, and outcome, as directed
Review relevant CIC reports and handle accordingly
Cross train for coverage of other positions in the CIC
Follow all applicable government regulations including HIPAA.
Display behavior which exemplifies employee code of conduct guidelines.
Other duties as assigned; Job duties may vary by location.
**Registered Pharmacy Technician with South Carolina Board of Pharmacy required within 2 weeks of hire**
HOURS: 3P-11:30P, Monday-Friday with weekend rotation
Required Qualifications If not already Registered Pharmacy Technician in SC, must apply for registration with the SC Board of Pharmacy upon accepting offer.
Healthcare experience required.
Preferred Qualifications State and/or Nationally Certified Pharmacy Technician preferred
Education High School Diploma or equivalent required
Business Overview At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Now hiring in your community CVS Pharmacy’s 60,000 Pharmacy Technicians are the first point of contact for patients visiting our retail locations. As a CVS Health Pharmacy Technician you will use your knowledge and skill to help thousands of people get the medications they need to improve their health. To learn more about the different kinds of Pharmacy Technician roles, and other current openings, select from the dropdown below. We’re actively hiring pharmacy technicians to help administer COVID-19 vaccines and care for patients across the United States. Learn more at https://jobs.cvshealth.com/2020. About CVS Health At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status.