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Pre-Authorization Specialist
<p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><i>This position is Remote in the states of Washington OR Oregon. You will have the flexibility to work remotely* as you take on some tough challenges.</i></span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">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 <strong>Caring. Connecting. Growing together.</strong></span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">The <strong>Pre-authorization Specialist</strong> implements, maintains and executes procedures and processes by which Optum performs its referral and authorization process. This position responds to inquiries from patients, staff and physicians pertaining to referral authorization questions. The position also researches medical history and diagnostic tests when requested, to assist in review, processing, and coordination of prospective, concurrent and retrospective referrals. </span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">This position is full-time, Monday - Friday. Employees are required to work during our normal business hours of 7:00am - 4:30pm Monday - Thursday and 8:00am - 12:00pm Friday PST. It may be necessary, given the business need, to work occasional overtime.</span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">We offer on-the-job training. The hours of the training will be aligned with your schedule </span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"> </span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><strong>Primary Responsibilities:</strong></span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><strong>Initiate Referral Authorizations:</strong></span></p><ul><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Acquires and maintains a working knowledge of Optum contracted health plans agreements and related insurance products</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Provides administrative and enrollment support for team to meet Company goals</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Gathers information from relevant sources for processing referrals and authorization requests</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Submits authorization & referral requests to health plan via avenue of insurance requirement. Including but not limited to website, phone, & fax</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Track authorization status inquires for timely response</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Maintains strong understanding of and educate our physicians, clinical teammates, patients and families regarding contracted health plans requirements related to Referrals/Pre-authorization Management</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Acts as a liaison between providers, teammates, outside vendors, health plans, community services and patients to support Referrals/Pre-authorization management process and requirements</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Reviews benefit language and medical records to assist in completion of requested services, to meet health plan requirements</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Documents patient information in the electronic health record following standard work guidelines</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Coordinates with Clinical teammates and health plans to identify patients with Referrals/Pre-authorization Management needs</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Provides member services to all patient group</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Answers referral and authorization inquiries from health plans, our clinical areas, patients and outside Optum Physician office/facilities</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Assists in the development and implementation of job specific policy and procedures</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Assists in the collection of information for member and/or provider appeals of denied requests</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Identifies areas for potential improvement of patient satisfaction</span></li></ul><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><strong>Review Denied Claims (No Authorization/No Referral):</strong></span></p><ul><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Researches root causes of missing authorization/referral</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Processes no authorization, no referral denied claims based on Insurance plans billing guidelines</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Obtains retro authorizations, appeals denied claims, or writes off charges based on Optum charge write-off guidelines</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Provides feedback and follow up to clinical areas and appropriate parties</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Assists in the development and implementation of job specific policies and procedures to reduce no authorization no referral denied claims to increase revenue</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Initiates improvement in authorization timeliness, accuracy and reimbursement</span></li></ul><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><strong>Utilization Management Medical Review:</strong></span></p><ul><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Processes Insurance plan referrals in EPIC</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Utilizes Prior Authorization list, MCG, NCCN, and individual insurance plan medical guidelines/policies to determine administrative review, what is needed for clinical review, and manages the work flows accurately</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Reviews clinical records to match insurance medical guidelines/policies, acquires additional records if necessary </span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Discuss medical guidelines with insurance plan to reduce referral/prior authorization denial rate, expedite referral authorization process, and to keep peer to peer opportunities to minimal </span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Document accurately and timely in medical record</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Processes referrals in timely manner to improve patient’s satisfaction</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Other duties as assigned</span></li></ul><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"> </span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">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.</span></p><br><br><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><strong>Required Qualifications:</strong></span></p><ul><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">High School Diploma / GED OR equivalent years of work experience</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Must be 18 years of age OR older</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">1+ years of experience in healthcare, including understanding of health plan related operations</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Experience in Referrals/Pre-authorization Management/Claims billing</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Experience with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Experience with Microsoft Outlook, Microsoft Word & Microsoft Teams</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Experience with EHR/EMR systems (i.e.Epic)</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Willingness and ability to travel annually for an on-site meeting at the Everett, WA office.</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Ability to work full time. Employees are required to work during our normal business hours of 7:00am - 4:30pm Monday - Thursday and 8:00am - 12:00pm Friday PST. It may be necessary, given the business need, to work occasional overtime</span></li></ul><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"> </span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><strong>Preferred Qualifications:</strong></span></p><ul><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">1+ years of experience in Referrals/Pre-authorization Management</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">1+ years in appeal writing and processing</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">1+ years working knowledge of EOB, COB, Remits, and CMS 1500</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Knowledge of organizational policies, procedures, & systems</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Working knowledge of CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy</span></li></ul><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"> </span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><strong>Telecommuting Requirements:</strong></span></p><ul><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Reside within the states of Washington OR Oregon</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Ability to keep all company sensitive documents secure (if applicable)</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Required to have a dedicated work area established that is separated from other living areas and provides information privacy</span></li><li><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service</span></li></ul><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"> </span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy</span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"> </span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;">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 - $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable.</span></p><p><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"> </span></p><p style="text-align:center;"><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><i>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.</i></span></p><p style="text-align:center;"><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><i> </i></span></p><p style="text-align:center;"><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><i> </i></span></p><p style="text-align:center;"><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><i>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.</i></span></p><p style="text-align:center;"><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><i> </i></span></p><p style="text-align:center;"><span style="font-family:Tahoma, Geneva, sans-serif;font-size:10px;"><i>UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.</i></span></p>