Senior Pharm PA/Appeals Technician - Remote in Maine, Vermont, Wyoming, & Iowa

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. As a Senior Pharmacy Technician in Prior Authorization, you will provide expertise and customer service support to members, customers, and 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. In this role, you will primarily answer prior authorization inbound calls (up to 50 to 70 calls per day) from providers/members and research and resolve formulary and benefit issues using the appropriate reference material. You will process authorizations through various computer systems and use job aids/policies/procedures ensuring the accuracy of all data and updating as necessary. Attention to detail is crucial as you will receive and process 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 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. You will also resolve issues and complaints in a timely manner and perform other duties as assigned by management. Training for this position is for 5 weeks, and the shift after training is an 8-hour shift with an hour lunch. Candidates must be available as early as 5 am and as late as midnight, working 5 days a week which may include weekends. There may be scheduled overtime and/or working on holidays depending on business needs.

Responsibilities
?? Answer prior authorization inbound calls from providers/members (up to 50 to 70 calls per day) and research and resolve formulary and benefit issues.
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?? Process authorizations through various computer systems and ensure the accuracy of all data, updating as necessary.
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?? Receive and process prior authorization requests made by providers and members for medications not inherently covered on a member's prescription drug plan.
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?? Ensure patient safety and quality of work, maintaining a safe and secure workspace.
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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
?? Active National or State Board Pharmacy Technician Licensure.
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?? Pharmacy Technicians Certification Board (PTCB) certification.
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?? State Board of Pharmacy Licensure in state of residence.
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?? ExCPT - Pharmacy Technician Certification with National Healthcareer Association (NHA).
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?? The National Board of Prior Authorization Specialist certification.
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?? 6+ months of customer service/customer relations experience with healthcare professionals.
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?? Basic proficiency with Microsoft Excel, Word, and Outlook.

Nice-to-haves
?? Knowledge of call center systems such as IEX.

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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