Note: The job is a remote job and is open to candidates in USA. Optum is a global organization that delivers care aided by technology to help millions of people live healthier lives. The Senior Pharmacy PA/Appeals Technician provides expertise and customer service support for prior authorization requests, ensuring compliance with legal and contractual requirements while maximizing productivity.

Responsibilities

• Manages a high volume of inbound and outbound calls, averaging 50+ daily
• Answering 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 material
• Process prior authorizations through multiple computer systems and use of job aids/policies/procedures ensuring the accuracy and compliance of all data and updating as necessary
• Resolve issues and complaints in a timely manner
• Handle inbound phone requests and gathers member data to provide information for pharmacist consultations
• Have 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 plan
• Performs other duties as assigned by management
• Patient 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 compromised
• Promote a culture of safety that is equitable, transparent, and engaging for patients, family caregivers, and healthcare workforce
• Enhance workforce safety and well-being by mitigating physical and psychological risks, analyzing hazard data, and implementing supportive workplace strategies
• Leadership will oversee the monitoring of safety event trends, provide feedback of safety initiatives, quality improvement efforts, and governance in order to develop responsive measurable action plans

Skills

• Active and unrestricted Pharmacy Technician license in the state of Wyoming
• Active and unrestricted Pharmacy Technicians Certification Board (PTCB) OR ExCPT - Pharmacy Technician Certification with National Healthcareer Association (NHA)
• 6+ months of experience in customer service/customer relations with healthcare professionals
• Basic 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)
• Currently located in the state of Wyoming
• Ability to work any shift from 5:00 AM to 12:00 AM timeframe with flexible hours, including OT and weekends and a rotating on call schedule every 3 weeks for 7 days in row
• Knowledge of Call Center systems such as CMS, IEX, CTI and TCS

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education ReimbursementA
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

Company Overview

Company H1B Sponsorship