senior pharmacy appeals Technician - cebu city, cebuUnitedHealth Group

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
Positions in this function prep, review and approve/deny requests for prescription prior authorization and/or appeal. Clerks scan, index and prepare documents related to prior authorization and/or appeal request, verifying and updating patient/member profile information. Techs and Pharmacists compile medical notes (disease state, drug treatment history and current drug plan) from patient/provider in support of the request, review request against decision tree and approval protocol, perform outreach for additional information as needed to support the request. Update approved requests in claims systems and inform patient/provider of approval. Forward applicable requests through additional review path as needed. Ensures Rx denial is communicated to patient/provider along with rationale.
Primary Responsibilities:
Conduct training classes for new-hire technicians / clerks
Conduct refresher training for existing technicians / clerks
Conduct cross-skilling training to existing technicians / clerks
Coordinate with other Learning and Development teams to enhance training curriculum
Send training reports pertaining to ongoing training classes
Lead by example in all aspects of the business
Provide floor and virtual support to production technicians in the absence of training classes
Analyze quality and feedback trends and provide recommended product-specific action plans
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
Bachelor's Degree in Medical Allied Course
An aptitude to handle change in a fast paced environment
Take ownership of timelines and do the appropriate follow ups
Flexible and has positive attitude towards work
Extensive work experience within own function
Work is frequently completed without established procedures
Works independently
May act as a resource for others
May coordinate others' activities.- Extensive work experience within own function
Requires current pharmacy technician state license or national certification without restrictions based on regulatory requirements of worksite
Preferred Qualifications:
Bachelor's Degree in Pharmacy or Nursing
Certified Pharmacy Technician
2+ years of experience in Prior Authorization / RX Businesses
Customer Service experience in a Call Center/BPO setting
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
Optum is a drug-free workplace. © 2020 Optum Global Solutions (Philippines) Inc. All rights reserved.
Job Keywords: Senior Pharmacy Appeals Technician, Pharmacy Appeals Technician, Appeals Technician, Pharmacist, Nursing, Certified Pharmacy Technician, RX Businesses, Cebu, Cebu City, Central Visayas
UnitedHealth Group

Cebu City, Cebu
Permanent
Full-time