Prior Authorization Pharmacy Tech

Business Unit: OptumRx
Start / End Date: 11/13//2023 - 5/31/2024
Contract but can go perm for A+ candidates (not guaranteed)
Pay: $19.27 (set rate based on location / not negotiable)
Summary
The essential functions of a Pharmacy Technician in Prior Authorization 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. Request 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.
*This is a Call Center environment. Candidates will receive prior-authorization requests via fax or incoming call and will compare them to a set of criteria on UHG's database. The goal is to get these requests approved for the patient so they can receive their medicine. If the prior-authorization is rejected, the candidates will try to resolve the issue for them by contacting doctors or pharmacists or seeing if there is a problem with their insurance, etc. *
A day in the life of a prior auth pharm tech - https://link.edgepilot.com/s/dc65bfba/uwNPYO_byUikOCcDljq8SA?u=https://optumrx.video.uhc.com/media/Day%2Bin%2Bthe%2BLifeA%2BPrior%2BAuthorization%2BPharmacy%2BTechnician/1_7p4gm24d?st=0

Responsibilities:
 

·       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.

·       Answer Prior Authorization inquiry calls or/and faxes as well as research and resolve formulary and benefit issues using the appropriate reference material.

·       Resolve issues and complaints in a timely manner.

·       Performs other duties as assigned by management.

·       Handles inbound phone requests and gathers member data to provide information for Pharmacist consultations.

Examples of a call they would receive: Members or MDO calling to find out why medications were denied. MDO wanting to initiate PA via phone call. De-escalation calls. Members or MDO staff needing to find formulary alternatives. Appeals and PA notes.
Metrics: Between 10 and 20 calls per hour. Average call time 400 seconds. Will start off with a glide path for the first 4 weeks in production.
Tech Skills: This position really requires that you have strong computer skills; such things as using a mouse, Ctrl and Alt commands, function keys, have good speed and accuracy in typing and the ability to navigate through a variety of screens and systems.  You may be navigating between 14 different systems at one time
Training
*Training is for 4 weeks. Training time is 8:00am-5:00pm. Monday- Friday. This training time is subject to change. CANNOT MISS ANY TIME DURING TRAINING
Shift: shifts can start as early as 8am and end as late as 11pm *MUST BE FLEXIBLE FOR ANY SHIFT DURING THIS TIMEFRAME. 8 hour shift + 30 min lunch
*They will receive a set schedule after training.  Shift is assigned by Optum and flexibility is key.
* There is scheduled Overtime and working on Holidays. Dependent on business needs, candidate could work up to 4 hours a day OT. Please make sure candidates are available to work OT on weekends as needed
Candidates cannot choose their schedules and must be flexible for any shift assigned
(4) Schedule 1: Mon – Fri 8:00am – 4:30pm
(3) Schedule 2: Mon – Fri 8:30am – 5:00pm
(3) Schedule 3: Mon – Fri 9:00am – 5:30pm
(3) Schedule 4: Mon – Fri 10:00am – 6:30pm
(3) Schedule 5: Mon – Fri 11:30am – 8:00pm
(2) Schedule 6: Mon – Fri 2:30pm – 11:00pm
Schedule 7: blank
(1) Schedule 8:  Mon – Thurs / Sat 9:00am – 5:30pm
(1) Schedule 9:  Tues – Sat 9:00am – 5:30pm
Qualifications
 

·       Active Florida Pharmacy Tech License (state regulations require techs have state license. Cannot only have national certification, but it is a plus if they have PTCB or NHA national cert)

·       1+ years Pharmacy Tech experience  (will consider someone with less than 1 year of pharm tech experience if they also have healthcare call center or other health insurance role)

·       Must be comfortable being on the phone most of the day - call center environment and will be held to metrics

·       Candidate must have their own home internet access/VPN (internet can be hard wired with Ethernet cord) *MINIMUM INTERNET SPEED REQUIRED: 25 DL and 10 UL

·       Candidate must also have a secure work space/office in their home

·       Candidate must have level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens)

·       Proficient with Microsoft Office *list on resume which programs - candidate needs to feel confident with the programs = don't list any they haven't really used

·       Excellent Attendance is a must

·       High school diploma / GED

·       Prefer candidates that have worked remote in the past - please highlight on resume

If interested you may send a copy of your updated resume at LQuijano@healthcaresupport.com
Thank you and have a good day!

If you are interested, you may call or send mean SMS at 321-248-6365 or send me an email along with your updated resume and screenshot of your internet speed showing both download and upload at LQuijano@healthcaresupport.com
Thank you and have a good day!