Senior Pharmacy Prior Authorization and Appeals Technician - Remote Opportunity with Optum

Transform Healthcare with Optum: Join Our Team as a Senior Pharmacy Prior Authorization and Appeals Technician

At Optum, we're on a mission to improve health outcomes and advance health equity on a global scale. As a leading global organization, we harness the power of technology and care to help millions live healthier lives. Our culture is built on diversity, inclusion, and a passion for making a difference. If you're looking for a role that not only challenges you but also rewards you for your expertise and dedication, you've come to the right place.

About the Position: Shaping the Future of Healthcare

We're seeking an experienced Senior Pharmacy Prior Authorization and Appeals Technician to join our team on a remote basis. This critical role involves providing top-notch customer service and clinical review for prior authorizations, ensuring compliance with legal and contractual requirements. As a Senior Pharmacy Prior Authorization and Appeals Technician, you will be the linchpin in our efforts to connect people with the care and resources they need.

Key Responsibilities: Delivering Exceptional Service

• Handle a high volume of prior authorization inbound calls (up to 50 to 70 calls per day) from providers and members, researching and resolving formulary and benefit issues with precision and care.


• Process authorizations through various computer systems, utilizing job aids, policies, and procedures to ensure data accuracy and update records as necessary.


• Review prior authorization requests for medications not covered under a member's prescription drug plan, applying established criteria and guidelines.


• Maintain patient safety and quality of work, ensuring a safe and secure workspace and communicating with leadership on any safety concerns.


• Resolve issues and complaints in a timely and professional manner, upholding the highest standards of customer service.


• Perform additional duties as assigned by management, demonstrating flexibility and a commitment to team success.


• Manage inbound phone requests, gathering member data to facilitate pharmacist consultations.

Essential Qualifications: Your Path to Success

To excel in this role, you must possess:

• An active and unrestricted licensure/certification as a Pharmacy Technician, such as PTCB, State Board of Pharmacy Licensure, ExCPT with NHA, or certification as a Prior Authorization Specialist.


• A minimum of 6 months of experience in customer service or customer relations, preferably within a healthcare setting.


• A basic level of proficiency in Microsoft Office applications, including Excel, Word, and Outlook.

Preferred Skills: Elevating Your Application

While not mandatory, the following skills and qualities can significantly enhance your candidacy:

• Familiarity with Call Center systems, such as IEX, which can streamline your workflow and improve efficiency.


• Strong written and oral communication skills, with the potential to positively impact our Net Promoter Survey (NPS) scores.


• A proven ability to follow through on tasks, ensuring that all responsibilities are completed to a high standard.

Career Growth and Learning Benefits: Your Future with Optum

At Optum, we're committed to your professional growth and development. As a Senior Pharmacy Prior Authorization and Appeals Technician, you'll have access to comprehensive training programs, career development opportunities, and the chance to work with a talented team of professionals. Our culture encourages continuous learning, ensuring that you stay at the forefront of industry trends and best practices.

Work Environment and Company Culture: What You Can Expect

As a remote team member, you'll enjoy the flexibility of working from home while being part of a dynamic and inclusive team. Our company culture is built on the principles of diversity, equity, and inclusion, fostering an environment where everyone feels valued and supported.

Compensation, Perks, and Benefits: A Rewarding Package

We offer a competitive salary and a comprehensive benefits package that includes:

• Paid Time Off and 8 Paid Holidays, plus a Floating Holiday.


• Medical Plan options, along with a Health Spending Account or Health Saving Account.


• Dental, Vision, Life, and AD&D Insurance, as well as Short-term and Long-Term Disability coverage.


• A 401(k) Savings Plan and Employee Stock Purchase Plan.


• Education Reimbursement and Employee Discounts.


• An Employee Assistance Program and Employee Referral Bonus Program.


• Flexible Work Arrangements and Voluntary Benefits, such as pet insurance and legal insurance.

Join Our Team: Make a Difference in Healthcare

If you're a dedicated professional looking for a challenging and rewarding role, we want to hear from you. As a Senior Pharmacy Prior Authorization and Appeals Technician with Optum, you'll be at the forefront of our mission to improve health outcomes and advance health equity. Apply now and take the first step towards a fulfilling career with a global leader in healthcare.

Ready to embark on this exciting opportunity? We are too! Apply now and let's start this journey together.

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