About the Company
OptumRx, a proud member of the UnitedHealth Group family, is a leading pharmacy benefit manager dedicated to making the health system work better for everyone. We innovate at the intersection of health, technology, and service, providing advanced solutions that improve patient outcomes, reduce costs, and enhance the overall healthcare experience. Our commitment to cutting-edge technology, including robust SaaS platforms, empowers our teams to deliver exceptional care and service nationwide.
Job Description
We are seeking a highly motivated and detail-oriented Prior Authorization Pharmacy Tech with a strong focus on utilizing SaaS platforms to join our dynamic team in Wesley Chapel, FL. In this critical role, you will be responsible for processing prior authorization requests for a wide range of medications, ensuring compliance with established protocols, and leveraging our advanced software solutions to streamline workflows and improve efficiency. This position requires a keen understanding of pharmacy operations, excellent communication skills, and a proactive approach to problem-solving within a technology-driven environment.
Key Responsibilities
- Process prior authorization requests for prescribed medications accurately and efficiently, adhering to all regulatory guidelines and company policies.
- Utilize proprietary SaaS platforms and other technological tools to submit, track, and manage prior authorization cases.
- Communicate effectively with prescribers, pharmacies, and patients to gather necessary clinical information and resolve authorization delays.
- Review patient medical records and insurance information to determine eligibility and necessity for medication prior authorizations.
- Educate healthcare providers on prior authorization requirements and process guidelines.
- Maintain meticulous documentation of all prior authorization activities and communications within the designated systems.
- Collaborate with pharmacists and other healthcare professionals to ensure optimal patient care and medication access.
- Stay current with changes in medication guidelines, insurance formularies, and prior authorization regulations.
- Identify and escalate complex cases or system issues to appropriate internal teams for resolution.
Required Skills
- Certified Pharmacy Technician (CPhT) in good standing with the Florida Board of Pharmacy.
- Minimum of 2 years of experience in prior authorization or medical billing/insurance within a pharmacy or healthcare setting.
- Proven experience working with SaaS (Software as a Service) platforms or other healthcare technology solutions.
- Strong understanding of medication terminology, insurance plans, and PBM processes.
- Excellent verbal and written communication skills.
- Exceptional attention to detail and organizational abilities.
- Proficiency in basic computer applications and data entry.
- Ability to work independently and as part of a collaborative team in a fast-paced environment.
Preferred Qualifications
- Associate's or Bachelor's degree in a related healthcare field.
- Experience with OptumRx or similar large PBM systems.
- Familiarity with various therapeutic categories and complex medication regimens.
- Experience in a call center or high-volume processing environment.
Perks & Benefits
- Comprehensive medical, dental, and vision insurance plans.
- Generous paid time off (PTO) and company-paid holidays.
- 401(k) retirement plan with company matching contributions.
- Tuition reimbursement and professional development opportunities.
- Employee assistance program (EAP).
- Wellness programs and incentives.
- Life and disability insurance.
- Flexible spending accounts (FSA) and health savings accounts (HSA).
How to Apply
If you are interested in this position, please click the "Apply Now" button below. To ensure your application is properly considered, please prepare the following:
- An up-to-date Resume or CV
- A brief cover letter summarizing your experience and motivation
Applications are reviewed on a rolling basis. Only shortlisted candidates will be contacted for an interview.
⚠️ Important Disclaimer
Welcome to Westford Trust. We publish job opportunities aggregated from public sources, employers, and job portals. We never charge any fees to access or use our website; all information is provided entirely for free.
Westford Trust does not directly offer or manage these positions, nor are we directly involved in the hiring process for the vacancies published on https://career.westfordtrust.com.
If you suspect a fraudulent listing or have any questions, please contact us at techturna@gmail.com.