Financial Clearance Representative Associate, Retail Pharmacy Prior Authorization
About The Position
Opportunities at Optum, in strategic partnership with Allina Health. As an Optum employee, you will provide support to the Allina Health account. 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. Job Summary: Responsible for completing the financial clearance process and creating the first impression of Optum services to patients, their families, and other external customers. You will articulate information in a manner that patients, guarantors, and family members understand and will know what to expect regarding their financial responsibilities. Work with medical staff, nursing, ancillary departments, insurance payers, and other external sources to assist families in obtaining healthcare and financial services. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Requirements
- High School Diploma/GED (or higher)
- 6+ months of experience with insurance and pharmacy benefit verification, pre-experience with prior authorization activities in healthcare business office/insurance operations
- 6+ months of experience using basic retail medication knowledge
- Intermediate level of proficiency with Microsoft Office products
- Must be 18 years of age OR older
- Excellent customer service skills
- Excellent written and verbal communication skills
- Demonstrated ability to work in fast paced environments
Nice To Haves
- Associate degree or Vocational degree in Business Administration, Health Care Administration, Public Health, or Related Field of Study
- Experience working with clinical staff
- Previous experience working in outpatient and/or inpatient healthcare settings
- Experience working in clinical documentation
- Previous experience working with a patient's clinical medical record
- Retail pharmacy experience
- EPIC experience
- Payer portals and/or covermymeds experience
- CphT or CMA certification
Responsibilities
- Verify insurance eligibility and completes automated insurance eligibility verification, when applicable and appropriately documents information in Epic
- Confirm that a patient's health insurance(s) is active and covers the patient's medication
- Review and analyze patient visit information to determine whether authorization is needed and understands payor specific criteria to appropriately secure authorization and clear the account prior to service where possible
- Ensure that initial and all subsequent authorizations are obtained in a timely manner
- May provide mentoring to less experienced team members on all aspects of the revenue cycle, payer issues, policy issues, or anything that impacts their role
- Initiating prior authorizations for medications
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Insurance Carriers and Related Activities
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
