Senior Pharm PA/Appeals Technician - Remote

About the position 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 turnaround 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. The primary responsibilities include answering prior authorization inbound calls (up to 50 to 70 calls per day) from providers/members, researching and resolving formulary and benefit issues using the appropriate reference material, and processing authorizations through various computer systems while ensuring the accuracy of all data. Patient safety and quality of work are 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. The technician will also resolve issues and complaints in a timely manner and perform other duties as assigned by management. Training is for 5 weeks, with training time from 8:00 am to 5:00 pm local time, Monday to Friday. After training, the shift will be an 8-hour shift with an hour lunch, and candidates must be available as early as 5 am and as late as midnight. Candidates will work 5 days a week, which may include weekends, and there may be scheduled overtime and/or working on holidays depending on business needs. Candidates must have their own home internet access and a secure workspace/office in their home. Excellent attendance is a must.

Responsibilities

• Answer prior authorization inbound calls from providers/members (up to 50 to 70 calls per day).

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• Research and resolve formulary and benefit issues using appropriate reference material.

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• Process authorizations through various computer systems and ensure the accuracy of all data.

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• Document interactions with callers per contractual and regulatory requirements.

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• Provide clinical review for authorizations in compliance with legal and contractual requirements.

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• Resolve issues and complaints in a timely manner.

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• Perform other duties as assigned by management.

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• Gather member data to provide information for pharmacist consultations.

Requirements

• 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), or The National Board of Prior Authorization Specialist.

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• 6+ months of Customer Service/Customer Relations experience with healthcare professionals.

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• Basic level of proficiency with Microsoft Excel, Word, and Outlook.

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• Ability to work any shift in the 5:00 AM to 12:00 AM timeframe with flexible hours, including overtime and weekends.

Nice-to-haves

• Knowledge of call center systems such as IEX.

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• Strong communication skills, both written and oral, to improve Net Promoter Survey (NPS).

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• Ability to follow through on tasks.

Benefits

• Paid Time Off which accrues with the first pay period plus 8 Paid Holidays + Floating Holiday.

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• Medical Plan options along with participation in a Health Spending Account or a Health Saving account.

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• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.

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• 401(k) Savings Plan, Employee Stock Purchase Plan.

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• Education Reimbursement.

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• Employee Discounts.

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• Employee Assistance Program.

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• Employee Referral Bonus Program.

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• Flexible Work Arrangement.

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• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).

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