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Senior Pharm PA/Appeals Technician

4 months ago

Augusta, United States UnitedHealth Group Full time

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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 Maine or Vermont, you will enjoy 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 materialProcess authorizations through various computer systems and use of job aid/policies/procedures ensuring the accuracy of all data and updating as necessaryHave 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 planPatient 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 compromisedResolve issues and complaints in a timely mannerPerforms other duties as assigned by managementHandles inbound phone requests and gathers member data to provide information for pharmacist consultationsTraining is for 5 weeks. Training time is 8:00am-5:00pm local time. Monday- Friday. This training time is subject to changeShift after training is an 8-hour shift with an hour lunch. Candidate must be available as early as 5am and as late as midnightCandidate 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 needsCandidate 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 homeCandidate 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

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Floating HolidayMedical Plan options along with participation in a Health Spending Account or a Health Saving accountDental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage(k) Savings Plan, Employee Stock Purchase PlanEducation ReimbursementEmployee DiscountsEmployee Assistance ProgramEmployee Referral Bonus ProgramFlexible Work ArrangementVoluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)More information can be downloaded at: 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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 residenceExCPT – 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 professionalsBasic 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 7:00 AM to 12:00 AM timeframe with flexible hours, including OT and weekends

Preferred Qualifications:

Knowledge of Call Center systems such as IEX

Soft Skills:

Experience and strong communication skills, both written and oral that will help improve Net Promoter Survey (NPS)Ability to follow through on tasksPhysical 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 computerAbility to have their own home internet access (internet can be hard wired with ethernet cord) Have a secure workspace/office in their homeHave level skill with working with PC (ex. using mouse and keyboard, accessing, and navigating through multiple systems and screens)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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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