Access and Reimbursement Specialist

UnitedHealth Group • Las Vegas, NV

233d • $19 - $38 • Remote

About The Position

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. You're looking for the next great thing for your career. How about supporting teams architecting the future of health care? Optum Frontier Therapies is a business pioneering a better approach to care for people with rare diseases; we are on a mission to support people with compassion while creating access to therapies at the frontier of health care. With us, you'll find a fast-paced, passionate, and professional culture where you can use your talent and our resources to make a huge impact-ensuring that all people, no matter how unique, have the ability to access a better tomorrow. Take this opportunity to start doing your life's best work. The Access & Reimbursement Pharmacy Specialist will be responsible for the benefit verification research and benefit initiation of pharmacy claims. To ultimately obtain patient access the role includes ongoing follow up on prior authorizations and appeals. The role also includes identifying and obtaining financial assistance.

Requirements

• Valid license, registration and/or certification, in good standing, to practice as a Pharmacy Technician as required by the Board of Pharmacy in the state employed
• Two (2) years of hands-on Pharmacy Claims Processing, Benefit Verification or Prior Authorization processing in an insurance or pharmacy setting; or Medical Claims Billing, or Medical Billing/Coding experience with a medical or health service provider
• Must be able to work 9:30 AM - 6:00 PM CST or 8:30 AM -5:00 PM MST

Nice To Haves

• Associate degree
• Retail Pharmacy experience
• Specialty Pharmacy experience
• Pharmacy Accreditation experience
• Proven work history working in a matrixed environment, call center, operations environment

Responsibilities

• Knowledgeable and proficient in pharmacy benefit structure of all major payer types including government and commercial payers
• Knowledgeable and proficient in the entire pharmacy prior authorization and appeals process for prescriptions medications
• Navigate calls to pharmacy benefit manager to determine and obtain patient benefit structure details, initiate overrides, and obtain contracting requirements
• Completes test claims or electronic verification of benefits when applicable
• Accurately collect the information required for each program and capture the information in a Customer Relationship Management system (CRM) or database
• Coordinates with board licensed healthcare professionals including nurses, pharmacists, or supervised pharmacy interns for information needed to complete Prior Authorizations, Appeals and third-party financial assistance forms
• Follows up with pharmacy plans and third-party financial assistance organizations for general information, status updates and determination details within specified timeframes
• Effectively explains prior authorization and appeal approval or denial details with customers in a way that is easily understood to fit the audience's needs
• Keeps current with the requirements and eligibility criteria for copay assistance from public, private, and non-profit organizations related to assigned programs to assist customers with enrolling into third party financial assistance opportunities when applicable
• Keeps current with existing treatment trends, treatment standards and updated indications related to assigned programs to complete Prior Authorization and Appeal forms
• Maintains a working knowledge of program guidelines, FAQ's, products, and therapeutic areas related to programs within the Frontier Therapies portfolio
• Reviewing, interpreting and reacting to data provided by clients and customers
• Coordinates the triage of patient prescription to the appropriate partner for fulfillment or administration
• Communicates customer statuses to the appropriate parties at specified intervals or as needed
• Resolve customer issues through basic troubleshooting and escalate potential problems or issues that require management's attention in a timely manner
• Maintains company, employee and customer confidentiality as well as compliance with all HIPAA regulations
• Provide recommendations to IT partners on system enhancements to better drive performance and quality
• Follows up with medical plans and grant organizations for general information, status updates and determination details within specified timeframes
• Effectively explains precertification's, predeterminations, and appeal approval or denial details with patients in a manner that is easily understood to fit the needs of the intended audience
• Completes special duties or projects as assigned by leadership

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree