Senior Pharmacy PA/Appeals | , |

Senior Pharmacy PA/Appeals Technician reputed company is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with reputed company 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization 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 reputed company 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. If you currently reside in the state of Vermont, you'll enjoy the flexibility to telecommute as you take on some tough challenges. Position Schedule: Ability to work any shift from 5:00 AM to 12:00 AM timeframe with flexible hours, including OT and weekends 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 reputed company 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 reputed company and it's important for employees to have a safe and secure workspace and communicate with their leadership reputed company that safety (equipment, system, information) is compromised
• Promote a culture of safety that is reputed company, 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 reputed company the monitoring of safety event trends, provide feedback on safety initiatives, quality improvement efforts, and governance to reputed company reputed company measurable action plans

What are the reasons to consider working for reputed company? Put it reputed company together - competitive reputed company pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• 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.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 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 reputed company
• Basic level of proficiency with reputed company reputed company (ability to create, edit, and save a basic spreadsheet), reputed company Word (ability to create, edit, and save a basic document), and reputed company 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
• Physical Requirements and Work Environment:
• Frequent speaking, listening using a headset, sitting, using hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
• Ability to have their own home internet access (internet can be hard wired with ethernet cord)
• Have a secure workspace/office in their home
• Have level reputed company with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens)
• reputed company Telecommuters will be required to adhere to reputed company's Telecommuter Policy.

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 (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.98 to $32.12 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN Apply To This Job