Remote Senior Pharmacy PA & Appeals Technician

Texas Health Institute; Sugar Land (TX); Remote; USD 25,000 - 44,000; Full time

Job summary

UnitedHealth Group seeks a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals, ensuring accurate, timely processing across channels. The role requires reviewing information, identifying missing data, and escalating as needed to pharmacists or clinicians.

Strong attention to detail and compliance are essential. The position offers telecommuting within a broad list of states, with a focus on meeting SLA/TATs and maintaining high-quality service in a fast-paced

Qualifications

• Active and unrestricted Pharmacy Technician licensure, registration, or certification as required by the state of residence and business needs.
• 6+ months of experience in customer service, healthcare, pharmacy, call center, or direct interaction with healthcare professionals
• Basic level of proficiency with Microsoft Excel, Word, Outlook, and Teams
• Ability to work any shift within the 5:00 AM to 12:00 AM timeframe, including flexible hours
• Currently located in the state of Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, & Wyoming

Responsibilities

• Manage a high volume of inbound and outbound calls, averaging 50+ daily, while maintaining professionalism, accuracy, and customer service expectations
• Respond to prior authorization inquiries and requests from providers, pharmacies, members, and internal partners using approved scripts, reference materials, job aids, policies, and procedures
• Review and process prior authorization requests through multiple computer systems, ensuring required information is complete, accurate, and documented in accordance with compliance, regulatory, client, and business requirements
• Research formulary, benefit, medication, eligibility, and plan-specific information to help resolve prior authorization questions, benefit issues, and case-processing barriers
• Gather and verify member, provider, prescriber, pharmacy, medication, diagnosis, and clinical support information needed for pharmacist consultation or clinical review

Skills

Customer service

Communication skills

Multitasking

Education

PTCB certification

State board licensure/registration

ExCPT certification

Tools

Excel

Word

Outlook

Teams

Job description

UnitedHealth Group seeks a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals, ensuring accurate, timely processing across channels. The role requires reviewing information, identifying missing data, and escalating as needed to pharmacists or clinicians.

Strong attention to detail and compliance are essential. The position offers telecommuting within a broad list of states, with a focus on meeting SLA/TATs and maintaining high-quality service in a fast-paced