Senior Pharmacy PA/Appeals Technician

UnitedHealth Group • Winooski, VT

2d • Remote

About The Position

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.

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), The National Board of Prior Authorization Specialist
• 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)
• Ability to work any shift from 5:00 AM to 12:00 AM timeframe with flexible hours, including OT and weekends
• Currently located in the state of Vermont
• Frequent speaking, listening using a headset, sitting, using hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
• Ability to have their own home internet access (internet can be hard wired with ethernet cord)
• Have a secure workspace/office in their home
• Have 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.
• Candidates are required to pass a drug test before beginning employment.

Nice To Haves

• Knowledge of call center systems such as CMS, IEX, CTI and TCS
• Experience and strong communication skills, both written and oral that will help improve Net Promoter Survey (NPS)
• Ability to follow through on tasks

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
• 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
• 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

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 Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed