Pre-Authorization Specialist

This position is Remote in Washington OR Oregon. You will have the flexibility to work remotely

• as you take on some tough challenges.

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

The

Pre-authorization Specialist

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.

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 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.

We offer on-the-job training. The hours of the training will be aligned with your schedule (Monday-Thursday, 7 : 00am-4 : 30pm and Friday 8 : 00am-12 : 00pm PST)

Primary Responsibilities :

Initiate Referral Authorizations :

Acquires and maintains a working knowledge of Optum contracted health plans agreements and related insurance products

Provides administrative and enrollment support for team to meet Company goals

Gathers information from relevant sources for processing referrals and authorization requests

Submits authorization & referral requests to health plan via avenue of insurance requirement. Including but not limited to website, phone, & fax

Track authorization status inquires for timely response

Maintains strong understanding of and educate our physicians, clinical teammates, patients and families regarding contracted health plans requirements related to Referrals / Pre-authorization Management

Acts as a liaison between providers, teammates, outside vendors, health plans, community services and patients to support Referrals / Pre-authorization management process and requirements

Reviews benefit language and medical records to assist in completion of requested services, to meet health plan requirements

Documents patient information in the electronic health record following standard work guidelines

Coordinates with Clinical teammates and health plans to identify patients with Referrals / Pre-authorization Management needs

Provides member services to all patient group

Answers referral and authorization inquiries from health plans, our clinical areas, patients and outside Optum Physician office / facilities

Assists in the development and implementation of job specific policy and procedures

Assists in the collection of information for member and / or provider appeals of denied requests

Identifies areas for potential improvement of patient satisfaction

Review Denied Claims (No Authorization / No Referral) :

Researches root causes of missing authorization / referral

Processes no authorization, no referral denied claims based on Insurance plans billing guidelines

Obtains retro authorizations, appeals denied claims, or writes off charges based on Optum charge write-off guidelines

Provides feedback and follow up to clinical areas and appropriate parties

Assists in the development and implementation of job specific policies and procedures to reduce no authorization no referral denied claims to increase revenue

Initiates improvement in authorization timeliness, accuracy and reimbursement

Utilization Management Medical Review :

Processes Insurance plan referrals in EPIC

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

Reviews clinical records to match insurance medical guidelines / policies, acquires additional records if necessary

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

Document accurately and timely in medical record

Processes referrals in timely manner to improve patient's satisfaction

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 OR equivalent years of work experience

Must be 18 years of age OR older

1+ years of experience in healthcare, including understanding of health plan related operations

Experience in Referrals / Pre-authorization Management / Claims billing

Experience with computer and Windows PC applications, which includes the ability to learn new and complex computer system application

Experience with Microsoft Outlook, Microsoft Word & Microsoft Teams

Experience with EHR / EMR systems (i.e.Epic)

Ability to travel up to 10% of the time

Ability to work full time. Employees are required to have flexibility to work any of our 8-hour shift schedules 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.

Preferred Qualifications :

1+ years of experience in Referrals / Pre-authorization Management

1+ years in appeal writing and processing

1+ years working knowledge of EOB, COB, Remits, and CMS 1500

Knowledge of organizational policies, procedures, & systems

Working knowledge of CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy

Telecommuting Requirements :

Reside within Washington OR Oregon

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.

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 $17.74 - $31.63 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.

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