Referral and Prior Authorization Specialist

UnitedHealth Group-posted 3 months ago
$17 - $31/Yr
Full-time • Entry Level
Remote • Corvallis, OR
Insurance Carriers and Related Activities
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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. The Referral & Prior-Authorization Specialist coordinates and facilitates the process of internal and external referrals and authorizations for patients of The Corvallis Clinic.

  • Participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlines in the Service and Behavioral Standards Handbook.
  • Efficiently obtain all authorizations for medical procedures to be performed prior to patients scheduled date of service.
  • Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes.
  • Document all prior authorization information including approval dates, prior authorization number in patient chart.
  • Read medical documentation and perform medical chart review prior to requesting authorization.
  • Notify scheduling and clinical staff of delays in obtaining these authorizations.
  • Ensure that insurance carrier documentation requirements are met and authorization/referral documentation is scanned and documented in the patient's medical record.
  • Complete follow-up as needed with physicians, clinical staff, and insurance companies.
  • Monitor authorization requests to ensure timely processing and completion.
  • Communicate approvals and denials to the ordering physician and assist with any denials or issues to resolve.
  • Review denials and submit appeals if requested by physician in an effort to obtain approval by insurance companies.
  • Research, correct, and re-submit rejected and denied claims.
  • Inform supervisor about any changes or patterns when working denials of procedures.
  • Collaborate with other departments to assist in obtaining pre-authorizations in a cross-functional manner.
  • Handle high workload volume timely and accurately.
  • Perform other duties as assigned.
  • High School Diploma/GED (or higher).
  • 2+ years of experience in a medical office.
  • 2+ years of experience interacting with insurance companies.
  • 2+ years of experience in ICD-10 and CPT coding knowledge.
  • Intermediate level of computer proficiency (including Microsoft Outlook, Teams) and ability to use multiple web applications.
  • Basic level of computer proficiency including MS Word and Excel.
  • Ability to be on camera during work hours.
  • Reside within a commutable distance to 3680 NW Samaritan Drive, Second Floor, Corvallis, OR 97330 (for training purposes).
  • Access to a designated quiet workspace in your home with the ability to secure Protected Health Information (PHI).
  • Live in a location that can receive a UnitedHealth Group approved high-speed internet connection.
  • Knowledge of anatomy and physiology.
  • Knowledge of medical terminology.
  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
  • Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.
  • 401(k) Savings Plan, Employee Stock Purchase Plan.
  • Education Reimbursement.
  • Employee Discounts.
  • Employee Assistance Program.
  • Employee Referral Bonus Program.
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).
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