Prior Authorization Specialist – Remote in OR

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 Prior Authorization Specialist serves the patients, staff, and clinicians of Oregon Medical Group by requesting prior authorization approvals for planned, scheduled, or rendered procedures, services, or medications. The Prior Authorization Specialist is responsible for the timely submission of all documentation, forms, or electronic requests in a timely fashion to not impede our community’s access to care.

This position is full time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer 1-2 weeks of paid training. The hours during training will be 8:00am to 5:00pm, Monday – Friday.

If you are located in OR, you will have the flexibility to work remotely* as you take on some tough challenges.

                                                                                                                                                                        

Primary Responsibilities:

• Obtains insurance prior authorization for patient prescriptions, treatments, services, or procedures and re-authorization for additional units including performing any retro-authorization requests as allowed by payers; appeal prior authorization denials and help facilitate peer-to-peer reviews as needed. Appropriately document authorization details in the patient’s medical record including notifying clinical staff of benefit limitations and authorization status.
• Monitor pre-auth denials for trends and provider documentation issues, and escalate to Lead or Supervisor as appropriate.
• Meet or exceed productivity expectations after orientation period to ensure requests are being processed timely.
• Assist Operation teams with processing externally referred patients.
• Ensure registration and insurance are accurately loaded into system, and make any necessary corrections.
• Escalate any issues or concerns to the appropriate department or manager as necessary.
• Maintain strictest confidentiality.
• Work on assigned projects as needed.
• Perform 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 / GED
• Must 18 years of age or older
• 1+ years of experience in a medical billing office, medical office setting, or insurance company to include processing claims and a working knowledge of CPT, ICD-10, and HCPC coding
• Ability to work full time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime

                                                                                                                                                                                                                                                                                                                                              

Preferred Qualifications:

• Familiarity with payer authorization processes including interfacing with payers via calls, fax, or portals

                                                                                                                                                                                                                                                                                                      

Telecommuting Requirements:

• Reside within OR
• 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

                                                                                                           

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.

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 

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

 

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