Remote Senior Pharmacy PA/Appeals Technician

Optum; Sugar Land (TX); On-site; USD 24,796 - 44,083; Full time

Job summary

Optum is seeking a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals for formulary and non-formulary medications. You will receive, research, document, and process PA requests across phone, fax, and electronic systems, ensuring accuracy and compliance with criteria and SLAs.

Residents within Texas and other listed states may telecommute. The role emphasizes attention to detail, collaboration with pharmacists and clinicians, and timely, compliant case processing in

Qualifications

• Active and unrestricted pharmacy technician licensure as required by state of residence
• PTCB certification or ExCPT certification and state licensure
• Experience with prior authorization or formulary review is preferred

Responsibilities

• Manage high-volume inbound/outbound calls (50+ daily) and professional customer service
• Review and process prior authorization requests across multiple systems
• Gather and verify member, provider, medication, diagnosis, and clinical information for pharmacist consultation
• Identify missing information and route to appropriate pharmacist or clinician when needed
• Maintain documentation, comply with HIPAA, and adhere to turnaround times and SLAs

Skills

Attention to detail

Communication

Time management

Education

PTCB Certification

State Pharmacy licensure

ExCPT Certification

Tools

Microsoft Excel

Microsoft Word

Outlook

Teams

Job description

Optum is seeking a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals for formulary and non-formulary medications. You will receive, research, document, and process PA requests across phone, fax, and electronic systems, ensuring accuracy and compliance with criteria and SLAs.

Residents within Texas and other listed states may telecommute. The role emphasizes attention to detail, collaboration with pharmacists and clinicians, and timely, compliant case processing in