Senior Pharm PA/Appeals Technician - Remote in Florida, North Carolina, & Georgia

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 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 Florida, North Carolina, or Georgia, you will have the flexibility to telecommute as you take on some tough challenges. The role primarily involves answering prior authorization calls (up to 50 to 70 calls per day) from providers/members, researching and resolving formulary and benefit issues using appropriate reference material, and processing authorizations through various computer systems. Attention to detail is crucial as 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 are paramount, and employees must communicate with their leadership when safety 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, and the shift after training is an 8-hour shift with an hour lunch, requiring availability as early as 5am and as late as midnight, including potential weekend days and overtime depending on business needs.

Responsibilities
• Answer prior authorization inbound calls (up to 50 to 70 calls per day) from providers/members.
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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 ensuring the accuracy of all data and 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, communicating with leadership when safety is compromised.
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• Resolve issues and complaints in a timely manner.
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• Gather member data to provide information for pharmacist consultations.
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• Perform other duties as assigned by management.

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.
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• Ability to work 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.

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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