Senior Pharmacy PA/Appeals Technician

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

Additional Qualifications/Responsibilities

• 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 & Quality Initiatives

• 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 on safety initiatives, quality improvement efforts, and governance to develop responsive measurable action plans

What are the reasons to consider working for UnitedHealth Group?

• Competitive base pay
• A full and comprehensive benefit program
• Performance rewards
• A management team who demonstrates their commitment to your success

Required Qualifications

• Licensure Requirement - 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

Preferred Qualifications

• Knowledge of call center systems such as CMS, IEX, CTI and TCS

Soft Skills

• Experience and strong communication skills, both written and oral that will help improve Net Promoter Survey (NPS)
• Ability to follow through on tasks