Senior Pharmacy PA​/Appeals Technician

Overview

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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 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.

Position

Schedule:

Ability to work any shift from 5:00 AM to 12:00 AM timeframe with flexible hours, including OT and weekends

On-Call

Schedule:

On call schedule is every 3 weeks for 7 days in row, pay includes a flat daily rate whether called in or not & includes normal hourly rate if called in

If you reside within the states of Wyoming
, you will enjoy the flexibility to telecommute
* as you take on some tough challenges.

Primary 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

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…