Prior Authorization Analyst – National Remote

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. 

As the Prior Authorization Analyst, you will be vital to our success and drive quality and efficiency for Prior Authorization configuration and documentation. You will join a team that plays a vital role in ensuring we consistently meet and exceed market expectations for Prior Authorization requirements.

This position is full-time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am – 5:00 pm local time.  

We offer weeks of paid on-the-job training. May require different hours for 1st week of onboarding.

You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

• Serve as primary resource to coordinate prior authorization requirements in Facets and other supporting tools and systems
• Subject Matter Expert for authorization SOT and rules
• Work incoming tickets for new prior authorization requirements and maintenance with meeting expected turn-around times for completion
• Coordinating and / OR conducting standard audits to confirm accuracy of Prior Authorization requirements configuration across systems and tools to be in accordance with source of truth
• Assist with creation and maintenance of process flows and other documentation to support audits and configuration
• Participate in audits to support correct configuration
• Collaborate with other Configuration or Operational teams to support changes as needed
• Responding to Incoming inquiries regarding Prior Authorization questions and issues.
• Promote understanding of source of truth for authorization requirements across markets/payors.
• Create and maintain Standard Operating Procedures relative to Prior Authorization processes
• May works directly with auditors or on action plans and remediation
• Works with minimal guidance; seeks guidance only on complex tasks
• Provides explanations and information to teams, leadership and auditors
• Hosting and participating in meetings as a Subject Matter Expert
• Other related job duties as assigned

 

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 equivalent work experience
• Must be 18 years of age OR older
• 1+ years of experience with Prior Authorization requirements
• 2+ years of Facets Benefit OR Pricing Configuration experience
• 1+ years of experience with facilitating meetings
• 1+ years working with Medicare, Medicaid OR Commercial products
• Knowledge of HealthCare systems business end-to-end processes 
• Knowledge in use of Microsoft Word, Microsoft Excel, and Microsoft Teams

• Ability to work between the hours of 8:00 AM – 5:00 PM local time from Monday – Friday

 

Preferred Qualifications:

• 1+ years of experience with documenting processes / SOP’s
• Experience with California State regulations for Medicare, Medicaid OR Commercial products
• Knowledge of Applications such as Visio, PowerPoint and Access
• Writing and Executing queries in SQL server
• Experience with claims operations

 

Telecommuting Requirements: 

• Ability to keep all company sensitive documents secure (if applicable) 
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy 
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy