Specialty Appeals Pharmacy Care Coordinator

UnitedHealth Group•Jeffersonville, IN

9h•$18 - $32•Remote

About The Position

The Specialty Appeals Pharmacy Care Coordinator 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 offering appeal assistance to provider offices, tracking appeal letters for submission, obtaining support documents, following up on appeal outcomes, and addressing issues and handling concerns from other corresponding departments. Schedule: Monday – Friday, will work an 8-hour shift between the business hours of 7am – 7pm CST You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Requirements

High School Diploma/GED
1+ years of experience in the customer service or healthcare industry
Intermediate level of proficiency with MS Office (Word, Excel, Outlook)
Ability to work independently Monday - Friday, any 8-hour shift between 7am - 7pm CST

Nice To Haves

Prior Authorization experience or Appeals experience
Experience in pharmacy or healthcare
Ability to manage multiple tasks and set priorities
Ability to establish and execute action plans; able to share your past successes
Ability to be diplomatic when faced with conflict, and always communicate in a professional and courteous manner
Ability to produce quality results with a detail-oriented focus
General knowledge of pharmacy laws, practices, and procedures
Knowledge of insurance and third-party billing systems

Responsibilities

Communicate with providers, patients, and pharmacy staff to obtain necessary clinical documentation, prior authorization denial letters, and appeal letters
Access multiple Optum resources to check PA statuses, insurance and appeal outcome statuses and benefits. Utilization of and proficiency in multiple internal processing systems is required for record keeping, tracking of determinations and potential denied prior authorizations needing an appeal letter/letter of medical necessity
Complete status checks with provider offices verifying appeal letter receipt and submission to insurance as well as complete status checks with insurances for outcome determination for appeal
Document case activity, communications, and correspondence in computer system to ensure completeness and accuracy of potential and completed appeal letters
Facilitate the appeal process between the patient, physician, and insurance company by requesting denial information or additional documentation and facilitate obtaining the denial letter from the insurance, patient or physician. Ensure all clinical information and documentation is obtained
Process orders to set up patient medication shipment
Extensive work experience within own function
Work is frequently completed without established procedures
Works independently
May act as a resource for others
May coordinate others' activities
Perform other related duties as assigned

Benefits

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.)
comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution