Authorization Team Lead

Role Description

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.

• Leads and supports a team of Authorization Specialists responsible for obtaining, tracking, and maintaining insurance authorizations for medical services and procedures.
• Serves as a primary point of contact for patients regarding authorization status, insurance requirements, and coverage-related questions, ensuring accurate and timely communication.
• Reviews patient records and insurance information to determine authorization needs, verifies benefits, and ensures compliance with payer guidelines and regulatory requirements.
• Coordinates with insurance carriers, physician offices, and clinical staff to submit prior authorization requests, appeals, and supporting documentation.
• Monitors authorization workflows and daily productivity to ensure all pending, approved, denied, or expiring authorizations are followed up on and resolved within required timeframes.
• Identifies denied or delayed authorizations, investigates root causes, and works proactively to resolve issues to prevent delays in patient care or revenue loss.
• Maintains accurate documentation and updates authorization status in the electronic health record (EHR) and billing systems by close of business (COB).
• Acts as a liaison between patients, providers, and insurance companies to facilitate clear communication and continuity of care.
• Assists leadership with onboarding, training, and ongoing development of Authorization team members, including payer-specific rules and best practices.
• Provides coaching, feedback, and performance guidance to junior Authorization staff through team meetings and on-the-job training, documenting strengths and improvement opportunities.
• Supports department leadership with quality audits, process improvements, and adherence to compliance, payer, and organizational policies.

Qualifications

• Minimum 1 year experience working in a customer service or call center environment.
• Experience verifying benefits with insurance companies.
• Data entry experience.
• Working knowledge in Microsoft Office, specifically Outlook and Word.

Requirements

• Home infusion or durable medical equipment (DME) experience.
• Experience working in a healthcare environment.
• Experience working with healthcare insurance.

Education

• Verifiable High School Diploma or GED is required.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process.