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Senior Pharm PA/Appeals Technician
3 months ago
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The essential functions of a Pharmacy Technician in Prior Authorization are providing expertise and customer service support to members, customers, and/or providers. This position exists to take incoming requests for prior authorizations, for formulary and non-formulary medications, while ensuring a high level of customer service and maximizing productivity. Requests can be received via fax or telephone, from providers' offices and pharmacists. The position provides clinical review for authorizations in keeping with legal and contractual requirements, including but not limited to turn around times (TATs) and service level agreements (SLAs). The technician must provide the information clearly, accurately and in a professional manner. Interactions with callers must be documented per contractual and various regulatory / legal requirements.
If you live in the state of Vermont, Maine, Indiana, Wyoming, Iowa, Michigan, or Alabama, you will have the flexibility to telecommute as you take on some tough challenges.
Primary Responsibilities:
- Primarily answering prior authorization with inbound calls (up to 50 to 70 calls per day) from providers/members as well as research and resolve formulary and benefit issues using the appropriate reference material
- Process authorizations through various computer systems and use of job aid/policies/procedures ensuring the accuracy of all data and updating as necessary
- Have sharp attention to detail, Using established criteria and guidelines, the pharmacy technician receives and processes prior authorization requests made by providers and members for medications not inherently covered on a member's prescription drug plan
- Patient Safety and Quality of work is paramount and it's important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised
- Resolve issues and complaints in a timely manner
- Performs other duties as assigned by management
- Handles inbound phone requests and gathers member data to provide information for pharmacist consultations
- Training is for 5 weeks. Training time is 8:00am-5:00pm local time. Monday- Friday. This training time is subject to change
- Shift after training is an 8-hour shift with an hour lunch. Candidate must be available as early as 5am and as late as midnight
- Candidate will work 5 days a week which may or may not include a weekend day(s)
- There may be scheduled overtime and/or working on holidays dependent on business needs
- Candidate must have their own home internet access (internet can be hard wired with Ethernet cord)
- Candidate must also have a secure workspace/office in their home
- Candidate must have level skill with working with PC (ex. using mouse and keyboard, accessing, and navigating through multiple systems and screens)
- Excellent attendance is a must
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Floating Holiday
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Flexible Work Arrangement
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at:
Required Qualifications:
- Licensure Requirement - Must have one of the following active and unrestricted licensure/certifications:
- Pharmacy Technicians Certification Board (PTCB)
- State Board of Pharmacy Licensure in state of residence
- ExCPT - Pharmacy Technician Certification with National Healthcareer Association (NHA)
- The National Board of Prior Authorization Specialist
- 6 + months of Customer Service/Customer Relations experience with healthcare professionals
- Basic level of proficiency with Microsoft Excel (ability to create, edit, and save a basic spreadsheet), Microsoft Word (ability to create, edit, and save a basic document), and Microsoft Outlook (ability to send emails)
- Ability to work any shift in the 5:00 AM to 12:00 AM timeframe with flexible hours, including OT and weekends
- Knowledge of call center systems such as IEX
- Experience and strong communication skills, both written and oral that will help improve Net Promoter Survey (NPS)
- Ability to follow through on tasks
- Physical Requirements and Work Environment:
- Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
- Ability to have their own home internet access (internet can be hard wired with ethernet cord)
- Have a secure workspace/office in their home
- Have level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens)
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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