Referral and Prior Authorization Specialist

UnitedHealth Group•Corvallis, OR

21h•$18 - $32•Remote

About The Position

This position is Remote in Oregon. If you are located within commutable distance to the office at 3680 NW Samaritan Drive, Corvallis, you will have the flexibility to work remotely as you take on some tough challenges. 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Prior-Authorization Specialist coordinates and facilitates the process of internal and external authorizations for patients of The Corvallis Clinic.

Requirements

High School Diploma/GED or equivalent years or work experience
Must be 18 years of age OR older
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
Computer proficiency (including Microsoft Outlook, Teams) and be able to use multiple web applications
Basic level of computer proficiency including Microsoft Word (create, edit, save) and Microsoft Excel (create, sort, view, filter)
Ability to be on camera for meetings during work hours
Ability to work full-time, Monday - Friday. Employees are required to work during our normal business hours of 8:00am - 4:30pm PST. It may be necessary, given the business need, to work occasional overtime.

Nice To Haves

Knowledge of anatomy and physiology
Knowledge of medical terminology
Reside within commutable distance to the office at 680 NW Samaritan Drive, Corvallis, OR 97330
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.
Strong communication and customer service skills both in person and via phone
Ability to work independently and maintain good judgment and accountability
Demonstrated ability to work well with others
Strong organizational and time management skills
Ability to multi-task and prioritize tasks to meet all deadlines
Ability to work well under pressure in a fast-paced environment
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

Responsibilities

Will participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlines in the Service and Behavioral Standards Handbook. To this end, employee will be expected to read, have familiarity, and embrace the principles contained within
Efficiently obtains all authorizations for medical procedures to be performed prior to patients scheduled date of service
Processes authorizations and submit clinical supporting documentation to insurance carriers
Documents all prior authorization information including approval dates, prior authorization number in patient chart
Reads medical documentation and does medical chart review prior to requesting authorization. Reviews the medical records, diagnosis and laboratory reports. Reviews accuracy and completeness of information requested and ensures that all supporting documents are present
Notifies scheduling and clinical staff of delays in obtaining these authorizations
Ensures that insurance carrier documentation requirements are met and authorization documentation is scanned and documented in the patient’s medical record. Reviews order to determine if testing will warrant obtaining an authorization or if the testing is a covered benefit not requiring an authorization through the patient’s insurance coverage. Maintains timely communication with ordering physicians and clinical staff when missing information has not been received
Completes follow-up as needed with physicians, clinical staff, and insurance companies
Monitors authorization requests to ensure timely processing and completion
Communicates approvals and denials to the ordering physician and assists with any denials or issues to resolve
Reviews denials and submits appeals if requested by physician in an effort to obtain approval by insurance companies
Researches, corrects, and re-submits rejected and denied claims. Prepares reconsiderations and works with the billing staff if the denial need to go to an appeals level
Informs supervisor about any changes or patterns when working denials of procedures
Collaborates with other departments to assist in obtaining pre-authorizations in a cross-functional manner
Ability to handle high workload volume timely and accurately
Performs other duties as assigned