Prior Authorization Specialist - Pharmacy Tech
Company: UnitedHealth Group
Location: Worcester
Posted on: September 15, 2023
Job Description:
Opportunities with Reliant Medical Group, part of the Optum
family of businesses. Join a community-based, multi-specialty,
physician-led organization where you will work with talented peers
on a common purpose: improving the quality, cost and experience of
health care. Here, we focus on delivering the best patient care,
rather than volume. Through innovation and superior care
management, we support patients and your well-being as a team
member. Join a team at the forefront of value-based care and
discover the meaning behind Caring. Connecting. Growing
together.--Position in this function serves on the team of subject
matter experts on prior authorizations for medications administered
in the Oncology/Infusion and clinic setting. Works closely with the
clinical staff and pharmacy services to ensure accurate, and timely
approvals, which maintain excellent patient care and optimize
revenue. Maintains a solid understanding of healthcare insurance
policies, drug information, medical benefits, medical terminology
and pharmacy benefitsPrimary Responsibilities:--
- Obtains prior authorizations for required clinic and infusion
medications and works with patients to minimize financial
barriers
- Verify patient insurance benefits. Track patient referrals
- Submit insurance authorizations
- Works as a patient advocate and functions as a liaison between
the patient and payer to answer routine and complex inquires,
reimbursement questions and avoid insurance delays. Obtains
insurance authorization and pre-certification for
chemotherapy/infusion services
- Researches additional or alternative resources for non-covered
services to prevent payment denials. Familiarity with physician
office billing and reimbursement, as well as medical and pharmacy
benefits
- Communicates with nursing and medical staff to inform them of
any restrictions or special requirements in accordance with
particular insurance plans. Provides prompt feedback to physicians
and management regarding issues with non-covered drugs
- Reports any problems, issues or payer trends, updates
coding/payer guidelines for clinical staff
- Maintains a good working knowledge of both oncology and
non-oncology authorization requirements for all payers, State and
federal regulatory guidelines for coverage and authorization.
Complies with patient confidentiality laws and regulations
- Provides coverage for Patient Financial Counselors
- Complies with health and safety requirements and with
regulatory agencies such as DPH, etc. Complies with established
departmental policies, procedures, and objectives
- Enhances professional growth and development through
educational programs, seminars, etc. Attends a variety of meetings,
conferences, and seminars as required or directed
- Performs other similar and related duties as required or
directed. Regular, reliable and predicable attendance is
requiredYou'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 equivalent
- 1+ years of relevant work experience
- Pharmacy Technician experience
- Knowledge of medical terminology, CPT and ICD codes, insurance
billing background
- Knowledge of oncology and infusion benefits
- Knowledge of various software applications such as Microsoft
Word, Excel, Outlook, etc
- Understanding of revenue cycle functions such as patient
access, billing, payments, and denials. Ability to review data and
provide the appropriate information to insurance companies in order
to secure insurance authorizationPreferred Qualifications:----
- Pharmacy Technician Certification
- Proven solid ability to multi-task and cover for others within
the department during absences
- Proven ability to work independently and be comfortable talking
with providers, staff, patients, and outside organizations
- Proven ability to organize multiple activities and effectively
handle a fast-paced, changing workload with daily deadlines
- Demonstrated accuracy in record keeping and documentation with
solid attention to detail
- Proven excellent follow-up skills with the ability to handle
multiple assignments simultaneously
- Demonstrated good judgement as well as attention to detail
while working well with a team
- Proven excellent communication, organizational and
interpersonal skillsUnless certification, licensure or registration
is required, an equivalent combination of education and experience,
which provides proficiency in the areas of responsibility listed in
this description, may be substituted for the above
requirements.Physical Requirements:
- Physical health sufficient to meet the ergonomic standards and
demands of the positionThe Organization reserves the right to
modify position responsibilities at any time, due to business
necessity.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:
OptumCare is an Equal Employment Opportunity/Affirmative Action
employers 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.--OptumCare is a drug-free workplace. Candidates are required
to pass a drug test before beginning employment.--
Keywords: UnitedHealth Group, Worcester , Prior Authorization Specialist - Pharmacy Tech, Healthcare , Worcester, Massachusetts
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