Senior Pharmacy PA/Appeals Technician

Realistic Job Preview VideoOptum 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.The essential functions of a Senior Pharmacy PA/Appeals Technician 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 currently reside in the state of Vermont, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.Position Schedule: Ability to work any shift from 5:00 AM to 12:00 AM timeframe with flexible hours, including OT and weekendsPrimary ResponsibilitiesManages a high volume of inbound and outbound calls, averaging 50+ dailyAnswering Prior Authorization inquiry calls/requests with customer service skills as well as research, clinical information system utilizations and resolve formulary and benefit issues using the appropriate reference materialProcess prior authorizations through multiple computer systems and use of job aids/policies/procedures ensuring the accuracy and compliance of all data and updating as necessaryResolve issues and complaints in a timely mannerHandle inbound phone requests and gathers member data to provide information for pharmacist consultationsAdditional Qualifications/ResponsibilitiesHave 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 planPerforms other duties as assigned by managementPatient Safety & Quality InitiativesPatient 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 compromisedPromote a culture of safety that is equitable, transparent, and engaging for patients, family caregivers, and healthcare workforceEnhance workforce safety and well-being by mitigating physical and psychological risks, analyzing hazard data, and implementing supportive workplace strategiesLeadership will oversee the monitoring of safety event trends, provide feedback on safety initiatives, quality improvement efforts, and governance to develop responsive measurable action plansWhat 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 IncludePaid Time Off which you start to accrue with your first pay period plus 8 Paid HolidaysMedical 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 coverage401(k) Savings Plan, Employee Stock Purchase PlanEducation ReimbursementEmployee DiscountsEmployee Assistance ProgramEmployee Referral Bonus ProgramVoluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required QualificationsLicensure 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 Specialist6 + months of experience in customer service/customer relations 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 from 5:00 AM to 12:00 AM timeframe with flexible hours, including OT and weekendsCurrently located in the state of VermontPreferred QualificationsKnowledge of call center systems such as CMS, IEX, CTI and TCSSoft SkillsExperience 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, using 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.Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.98 to $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable.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.UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.#RPO #GREEN