[Hiring] Senior Pharmacy PA/Appeals Technician @UnitedHealth Group

Role Description

The essential functions of a Senior Pharmacy PA/Appeals Technician include supporting the prior authorization and appeals process by providing accurate, timely, and professional service to members, providers, pharmacists, and internal business partners. This role is responsible for:

• Receiving, researching, documenting, and processing prior authorization requests for formulary and non-formulary medications through multiple intake channels, including phone, fax, and electronic systems.
• Reviewing request information against established criteria.
• Verifying required member, provider, medication, diagnosis, benefit, and plan details.
• Identifying missing information and routing clinical questions or judgment-based decisions to the appropriate pharmacist or clinician.
• Maintaining compliance with regulatory and contractual requirements, adherence to turnaround times (TATs) and service level agreements (SLAs), and clear documentation of all interactions and case actions.

If you reside within the states of Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, & Wyoming, you will enjoy the flexibility to telecommute as you take on some tough challenges.

Qualifications

• Active and unrestricted Pharmacy Technician licensure, registration, or certification as required by the state of residence and business needs.
• Pharmacy Technician Certification Board (PTCB).
• State Board of Pharmacy licensure or registration in state of residence, if required.
• ExCPT – Pharmacy Technician Certification through the National Healthcareer Association (NHA).
• Other approved prior authorization or pharmacy technician certification, as accepted by the business.
• 6+ months of experience in customer service, customer relations, healthcare, pharmacy, call center, or direct interaction with healthcare professionals.
• Basic level of proficiency with Microsoft Excel, Word, Outlook, and Teams.
• Ability to work any shift within the 5:00 AM to 12:00 AM timeframe, including flexible hours, overtime, weekends, and holidays as required by business needs.

Requirements

• Manage a high volume of inbound and outbound calls, averaging 50+ daily.
• Respond to prior authorization inquiries and requests from providers, pharmacies, members, and internal partners.
• Review and process prior authorization requests through multiple computer systems.
• Research formulary, benefit, medication, eligibility, and plan-specific information.
• Gather and verify member, provider, prescriber, pharmacy, medication, diagnosis, and clinical support information.
• Identify missing or incomplete information and take appropriate follow-up action.
• Prioritize work to support required turnaround times for standard, expedited, urgent, and client-specific prior authorization requests.
• Maintain productivity, quality, schedule adherence, attendance, and documentation standards.
• Resolve issues and complaints in a timely, professional manner.

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.).