Pharmacy Care Coordinator, Appeals - National Remote

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.

Must be able to work Monday - Friday with a set schedule of hours between 7am - 7pm CST. Some Holidays may be required, based on business needs.

The Specialty Prior Authorization Patient Care Technician role 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 tracking appeal letters for submission, obtaining support documents, following up on prior authorization outcomes, and addressing issues and handling concerns from other corresponding departments.

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 authorizations, and appeal letters
• Accessing multiple Optum resources to check PA, insurance and appeal outcome status and benefits. Utilization of and proficiency in multiple internal processing systems for record keeping, tracking of determinations and potential denied prior authorizations needing an appeal letter/letter of medical necessity
• Completes status checks with insurance company and provider offices verifying letter receival and outcome status
• Document case activity, communications, and correspondence in computer system to ensure completeness and accuracy of potential and completed appeal letters
• Facilitate appeals process between the patient, physician, and insurance company by requesting denial information or additional documentation and facilitates obtaining the denial letter from the insurance, patient or physician
• Ensures all clinical information and documentation are obtained
• Assign completed appeals to coworkers, and coordinate communication through email, faxes and other forms of communication as needed (rotating schedule)
• Process orders to set up patient medication shipment
• Perform other related 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 higher)
• 1+ years of telephone customer service skills with the ability to build effective, appropriate and enduring customer and provider relationships
• Intermediate level of proficiency with clinical documentation from physician offices
• Intermediate level of proficiency with MS Word, Excel, SharePoint

Preferred Qualifications:

• PBM and / or Managed Care experience
• 1+ years of experience working with prior authorization, pre-certification, utilization review, and / or appeals
• Knowledge of healthcare insurance plans, denials, and appeal procedures
• Advanced computer skills; Experience in a paperless role

Soft Skills:

• Ability to work independently

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C residents is $16.54 to $32.55 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

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.

#RPO #GREEN

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