Remote Senior Pharmacy PA & Appeals Specialist

Optum; Portland (ME); Remote; USD 51,577,000 - 91,693,000; Full time

Benefits offered by this job

Medical plan options

401(k)

Education reimbursement

Employee discounts

Paid time off & holidays

Telecommute flexibility

Job summary

Optum in Maine or Vermont seeks a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals, processing requests from providers, members, and pharmacists. The role requires meticulous review against criteria, timely documentation, and collaboration with pharmacists, with remote options for Maine/Vermont residents.

You will join a team delivering healthcare support through technology, focusing on compliance, SLA adherence, and quality in a fast-paced environment.

Qualifications

• Active and unrestricted Pharmacy Technician licensure as required by state.
• 6+ months of experience in customer service, healthcare, call center, or related.
• Proficiency with Microsoft Office suite and basic systems navigation.
• Availability for 8-hour shifts 8am–8pm EST with on-call weekends.

Responsibilities

• Receive, research, document, and process prior authorization requests.
• Verify member, provider, medication, diagnosis, and plan details for each case.
• Escalate issues to pharmacists or clinicians when needed and ensure timely follow-up.
• Maintain accurate documentation and adhere to SLAs and regulatory requirements.

Skills

Pharmacy Technician

Customer Service

HIPAA compliance

Multisystem navigation

Excel

Communication

Education

Pharmacy Technician licensure

PTCB / ExCPT certification

Tools

CMS

IEX

CTI

TCS

Microsoft Excel

Job description

Optum in Maine or Vermont seeks a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals, processing requests from providers, members, and pharmacists. The role requires meticulous review against criteria, timely documentation, and collaboration with pharmacists, with remote options for Maine/Vermont residents.

You will join a team delivering healthcare support through technology, focusing on compliance, SLA adherence, and quality in a fast-paced environment.