Description:
WHO WE ARE:
Optum is a part of the UnitedHealth Group, a Fortune 7 company, serving 125 million individual consumers.
We are a diverse company with over 189,000 employees worldwide and over 14,000 employees in the Philippines.
We are a leader in nearly every aspect of today’s health care landscape.
We leverage on having the largest single proprietary network of physicians, hospitals, health facilities, and caregivers in the United States. At Optum, we believe that what makes you special can inspire your life’s best work.
Welcome to one of the toughest and most fulfilling ways to help people, including you. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life’s best work.SM
Join us today and unlock a world of rewards and benefits for performance, career growth, work-life balance and the opportunity to pursue your passion.
WHAT WE OFFER:
Completion Bonus (Terms and Conditions Apply)
ROLE AND RESPONSIBILITIES:
Prior Authorization is the preliminary review of Prior Authorization requests based from Clinical Guidelines for each drug. The team helps in procuring the PA for the customer. The PA/Appeals Technician will assist members/providers by providing quality service through efficient and accurate prior authorization service support.
Review Prior Authorization requests (either through incoming faxes, or inbound calls) to make a PA determination based on clinical guidelines
Understand and interpret urgencies on Prescription
Enter prescriptions and verifying appropriate information
Sort Faxes/Answers calls submitted by providers for Prior Authorization
Queue faxes to correct departments and appropriate urgencies
Contact Patients, Pharmacists, and Doctor’s offices to resolve Prior Authorization issues
Research all failed fax numbers and addresses of members and find correct information to send correspondence on a timely matter
Recognize, interpret and evaluate inconsistencies, discrepancies and inaccuracies in the prescription data or records and appropriately alert and/or query the responsible party and supervisor
Flexibility to be multi-skilled to handle multiple work types of varying complexity within Prior Authorization
Be able to handle High-Touch clients, accurately and efficiently as assigned
Adhere to required up-training classes as needed by the business
Meet quality and productivity standards, schedule adherence and deadlines/turnaround times while maintaining a good attendance record.
Participate in Quality Improvement Activities.
Perform other duties as assigned by supervisor
Your role is critical in allowing our members, families, facilities and health professionals to have greater confidence in the exceptional care we provide. And for you, an everyday opportunity to do your life’s best work.SM
Requirements:
JOB QUALIFICATIONS:
Completed at least 2nd year of College. Call Center experience of at least 6 months in an NPS-driven voice account required, or Graduate of any Medical Allied Course (BS Nursing, BS Pharmacy, etc.)
Certified Pharmacy Technician: Pharmacy Benefit Management Certified Technician Training (PBMCT) Certified (Certification to be completed after hiring)
Above average communication skills, both oral and written
Can type 35-50 WPM
Can pass CAT Assessment with a minimum score of 2.7 or Versant Testing with a minimum score of 60
Working knowledge of Excel and Microsoft Office products
Should have understanding / willing to learn interpreting the medications and dosages.
Has keen eye for detail, creative, resourceful, committed, and flexible
Willing to work night and shifting schedules
Willing to work long hours if needed
