Referral and Prior Authorization Specialist

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

The Referral & Prior-Authorization Specialist coordinates and facilitates the process of internal and external referrals and authorizations for patients of The Corvallis Clinic.

Schedule: Monday through Friday 8 am to 4:30 pm.PST

Location: You’ll enjoy the flexibility to telecommute* from anywhere within a commutable distance to Corvallis, OR .  You will work from home when not in training.  Training will be held at 3680 NW Samaritan Drive, First Floor, Corvallis, OR 97330.

Primary Responsibilities:

• Will participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlines in the Service and Behavioral Standards Handbook. To this end, employee will be expected to read, have familiarity, and embrace the principles contained within

• Efficiently obtains all authorizations for medical procedures to be performed prior to patients scheduled date of service

• Processes referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes

• Documents all prior authorization information including approval dates, prior authorization number in patient chart

• Reads medical documentation and does medical chart review prior to requesting authorization. Reviews the medical records, diagnosis and laboratory reports. Reviews accuracy and completeness of information requested and ensures that all supporting documents are present

• Notifies scheduling and clinical staff of delays in obtaining these authorizations

• Ensures that insurance carrier documentation requirements are met and authorization/referral documentation is scanned and documented in the patient’s medical record. Reviews order to determine if testing will warrant obtaining an authorization or if the testing is a covered benefit not requiring an authorization through the patient’s insurance coverage. Maintains timely communication with ordering physicians and clinical staff when missing information has not been received

• Completes follow-up as needed with physicians, clinical staff, and insurance companies

• Monitors authorization requests to ensure timely processing and completion

• Communicates approvals and denials to the ordering physician and assists with any denials or issues to resolve

• Reviews denials and submits appeals if requested by physician in an effort to obtain approval by insurance companies

• Researches, corrects, and re-submits rejected and denied claims. Prepares reconsiderations and works with the billing staff if the denial need to go to an appeals level

• Informs supervisor about any changes or patterns when working denials of procedures

• Collaborates with other departments to assist in obtaining pre-authorizations in a cross-functional manner

• Ability to handle high workload volume timely and accurately

• Performs other duties as assigned

What are the reasons to consider working for UnitedHealth Group?  Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays

• Medical Plan options along with participation in a Health Spending Account or a Health Saving account

• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage

• 401(k) Savings Plan, Employee Stock Purchase Plan

• Education Reimbursement

• Employee Discounts

• Employee Assistance Program

• Employee Referral Bonus Program

• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

• More information can be downloaded at: http://uhg.hr/uhgbenefits

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma/GED (or higher)
• 2+ years of experience in a medical office
• 2+ years of experience interacting with insurance companies
• 2+ years of experience in ICD-10 and CPT coding knowledge
• Intermediate level of computer proficiency (including Microsoft Outlook, Teams) and be able to use multiple web applications
• Basic level of computer proficiency including MS Word and Excel
• Ability to be on camera during work hours
• Reside within a commutable distance to 3680 NW Samaritan Drive, Second Floor, Corvallis, OR 97330. (for training purposes)
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)

• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

• Knowledge of anatomy and physiology preferred

• Knowledge of medical terminology preferred

Soft Skills:

• Strong communication and customer service skills both in person and via phone 
• Ability to work independently and maintain good judgment and accountability 
• Demonstrated ability to work well with others
• Strong organizational and time management skills 
• Ability to multi-task and prioritize tasks to meet all deadlines 
• Ability to work well under pressure in a fast-paced environment 
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

    

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 to $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

    

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

    

    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

    

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

    

   

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