Prior Authorization Specialist – Kelsey Seybold – Hybrid in Pearland TX

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.  

Position in this function is under the supervision of the Business Services Supervisor, the Prior Authorization Specialist (PAS) is responsible for processing incoming referral requests by contacting the Health plans verbally or electronically to obtain prior authorization for services provided and directed by a Kelsey provider. The PAS is responsible for communicating, obtaining and/or providing all required information to the health plans to facilitate the approval process, such as the medical record or an extract of clinical information from the medical record, and all pertinent information required to obtain prior authorization. The PAS also responsible for accurately verifying and/or documenting in the practice management system all pertinent information conducive to proper claim adjudication by the health plan, including, but not limited to authorization numbers, CPT codes approved, authorized dates, start and expiration date, call reference numbers, health plan representative’s first and last name, and payor portal screenshots.  The PAS is responsible for initiating communication with the clinic/physician when a referral is denied and/or requires additional information, Peer to Peer Review, etc. The PAR is responsible for logging in to the designated phone queue to answer, direct and/or resolve any inquiries or directions regarding referrals. Additional duties include handling and appropriately directing referral status requests as needed. The PAS will also identify and report to the Management team any patterns, trends or workflow deficiencies that undermine department effectiveness. Other 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 or GED from an accredited program
• 2+ years of medical office experience either in a physician office or hospital setting, health plan, ACO, or other managed care setting.
• Experience navigating payor web portals

Preferred Qualifications:

• College level courses
• Experience with precertification and/or utilization management
• Knowledge of CPT & ICD 10 Coding methodologies

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 $17.98 to $32.12 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.