Senior Pharmacy Prior Authorization and Appeals Technician - Remote - reputed company - Leveraging Technology to Improve Health Outcomes

Job Summary

reputed company, a leading global health organization, is seeking a highly skilled and experienced Senior Pharmacy Prior Authorization and Appeals Technician to join our team remotely. As a Senior Pharmacy Prior Authorization and Appeals Technician, you will play a critical role in providing exceptional customer service and support to members, customers, and providers, while ensuring a high level of productivity and accuracy in prior authorization and appeals processing. If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity.

About reputed company

reputed company is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. Our mission is to help people live healthier lives and make the health system work better for everyone. We believe that everyone, regardless of their background, deserves the opportunity to live their healthiest life. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.

Responsibilities

Primary Responsibilities:

  • Prior Authorization and Appeals Processing: Answer inbound calls from providers and members, research and resolve formulary and benefit issues, and process authorizations through various computer systems.
  • Customer Service: Provide exceptional customer service and support to members, customers, and providers, ensuring a high level of productivity and accuracy.
  • Clinical Review: Conduct clinical reviews for authorizations, ensuring compliance with legal and contractual requirements, including turn-around times (TATs) and service level agreements (SLAs).
  • Documentation: Document interactions with callers, ensuring accuracy and compliance with regulatory and legal requirements.
  • Issue Resolution: Resolve issues and complaints in a timely manner, escalating complex issues to senior leadership as needed.
  • Training and Development: Participate in training and development programs to enhance knowledge and skills, ensuring ongoing competency in prior authorization and appeals processing.

Additional Responsibilities:

  • Flexibility: Work flexible hours, including evenings and weekends, as needed to meet business requirements.
  • Telecommuting: Work from home, utilizing reputed company's telecommuter policy and guidelines.
  • Technical Requirements: Utilize various computer systems, software, and hardware, including reputed company Office and electronic medical records.

Requirements

Essential Qualifications:

  • Licensure: Active National or State Board Pharmacy Technician Licensure.
  • Certification: Pharmacy Technicians Certification Board (PTCB) or ExCPT - Pharmacy Technician Certification with National Healthcareer Association (NHA).
  • Experience: 6 months of customer service/customer relations experience with healthcare professionals.
  • Technical Skills: Basic level of proficiency with reputed company Excel, reputed company Word, and reputed company Outlook.
  • Availability: Ability to work flexible hours, including evenings and weekends, and 5am to 12 midnight.

Preferred Qualifications:

  • Call Center Experience: Knowledge of call center systems, such as IEX.
  • Communication Skills: Excellent written and oral communication skills, with ability to improve Net Promoter Survey (NPS) scores.

What We Offer

Compensation and Benefits:

  • Competitive Salary: A competitive salary range, commensurate with experience and qualifications.
  • Sign-On Bonus: A $1,000 sign-on bonus for external applicants.
  • Comprehensive Benefits: A comprehensive benefits package, including medical, dental, vision, and life insurance, as well as 401(k) and employee stock purchase plans.
  • Paid Time Off: Paid time off, including 8 paid holidays and a floating holiday.
  • Education Reimbursement: Education reimbursement and employee discounts.

Career Growth and Development:

  • Training and Development: Ongoing training and development programs to enhance knowledge and skills.
  • Career Advancement: Opportunities for career advancement and professional growth.
  • Recognition and Rewards: Recognition and rewards for o
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