Specialty Appeals Pharmacy Care Coordinator

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Specialty Appeals Pharmacy Care Coordinator fills an integral role in investigating, tracking, and submitting appeals for specialty patients with acute and chronic disease states. In this role, you will be offering appeal assistance to provider offices, tracking appeal letters for submission, obtaining support documents, following up on appeal outcomes, and addressing issues and handling concerns from other corresponding departments. 

Schedule: Monday - Friday, will work an 8-hour shift between the business hours of 7am - 7pm CST

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

Primary Responsibilities:

• Communicate with providers, patients, and pharmacy staff to obtain necessary clinical documentation, prior authorization denial letters, and appeal letters
• Access multiple Optum resources to check PA statuses, insurance and appeal outcome statuses and benefits. Utilization of and proficiency in multiple internal processing systems is required for record keeping, tracking of determinations and potential denied prior authorizations needing an appeal letter/letter of medical necessity
• Complete status checks with provider offices verifying appeal letter receipt and submission to insurance as well as complete status checks with insurances for outcome determination for appeal
• Document case activity, communications, and correspondence in computer system to ensure completeness and accuracy of potential and completed appeal letters
• Facilitate the appeal process between the patient, physician, and insurance company by requesting denial information or additional documentation and facilitate obtaining the denial letter from the insurance, patient or physician. Ensure all clinical information and documentation is obtained
• Process orders to set up patient medication shipment
• Extensive work experience within own function
• Work is frequently completed without established procedures
• Works independently
• May act as a resource for others
• May coordinate others' activities
• Perform other related 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.)

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
• 1+ years of experience in the customer service or healthcare industry
• Intermediate level of proficiency with MS Office (Word, Excel, Outlook)  
• Ability to work independently Monday - Friday, any 8-hour shift between 7am - 7pm CST

Preferred Qualifications:  

• Prior Authorization experience or Appeals experience 
• Experience in pharmacy or healthcare 

Soft Skills:  

• Ability to manage multiple tasks and set priorities 
• Ability to establish and execute action plans; able to share your past successes 
• Ability to be diplomatic when faced with conflict, and always communicate in a professional and courteous manner 
• Ability to produce quality results with a detail-oriented focus 
• General knowledge of pharmacy laws, practices, and procedures 
• Knowledge of insurance and third-party billing systems  

*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 $17.98 to $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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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