Supervisor for Pharmacy Claims Prior Authorizations and Appeals - National Remote
Company: UnitedHealth Group
Location: Orlando
Posted on: March 20, 2023
Job Description:
You'll enjoy the flexibility to telecommute* from anywhere
within the U.S. 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 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 Supervisor for Pharmacy Claims Prior Authorizations and Appeals
-will be responsible for supervision of access and reimbursement
specialist team within the Optum Frontier portfolio. The supervisor
will have direct oversight of team members that may work onsite or
remotely across the country. Under direct supervision from the
Pharmacy Manager of PA's and Appeal, the Supervisor will be
responsible for direct oversight of the team of specialists. This
specialized team is responsible for the initiation and ongoing
follow up of all prior authorization, financial assistance and
appeals processes. The team triages prescriptions and medical
orders to participating pharmacies and providers once all coverage
obstacles have been resolved. This position requires a leader that
can accurately provide directions, teach researching techniques,
address and communicate medical and prescription insurance coverage
requirements as well as a comprehensive knowledge of Medicare,
Medicaid and commercial plan structures and standards.This position
will provide coaching, mentoring, and support in the development of
staff and recognize individual and team success that result in a
high-level of team engagement and commitment. - -
This position is full-time (40 hours/week) Monday to Friday.
Employees are required to have flexibility to work any of our
8-hour shift schedules during our normal business hours of 09:00am
- 05:00pm EST. It may be necessary, given the business need, to
work occasional weekends and overtime. -
*All Telecommuters will be required to adhere to UnitedHealth
Group's Telecommuter Policy.
Primary Responsibilities: -
- Work directly with leadership on recommended staffing needs
using time studies and workforce management tools -
- Focus on employee development and coaching continuously to
include monthly one-on-ones and interim and annual reviews
-
- Manage employee schedules ensuring fair and consistent
practices -
- Ensure policies and procedures are being followed. Become a
subject matter expert on all workflow and policies to inform of
work instruction and job aid content needs. -
- Work directly with training team to ensure all team members are
trained to policies and procedures and work instructions.
-
- Ensure team members remain compliant with all necessary
licensure and continuing education requirements -
- Maintain close relationship with peer supervisors to ensure
client needs are always exceeded -
- Navigate a highly matrixed organization using strong
relationship building skills and clear communication in both verbal
and written form -
- Drive understanding of systems to partner with leadership on
implementation teams to be a subject matter expert in capabilities
with understanding to inform on gaps and provide optionality for
forward planning of successful implementations -
- Develop metrics for self and direct reports that align to the
overall objective for the business -
- Ensure performance is tracked accurately utilizing internal
tools and processes. -
- Participate and lead monthly meetings - -
- Provide recommendations to IT partners on system enhancements
to better drive performance and quality - -
- Willingness to jump in and be an operator to ensure patients'
needs are met -
- Maintains a working knowledge of program guidelines, FAQ's,
products, and therapeutic areas related to assigned programs.
-
- Responsible for reviewing,---interpreting, and reacting to data
provided by clients and customers. -
- Knowledgeable and proficient in the entire prior authorization
and appeals process for prescriptions medications, infusions,
medical procedures, and devices. -
- Keeps current with existing treatment trends, treatment
standards and updated indications related to assigned programs to
complete pharmacy PA and Appeal forms and to write letters of
medical necessity when applicable. -
- Knowledgeable and proficient in Coding principles, including
CPT and HCPCS - - -
- Knowledgeable and proficient in Medical and pharmacy benefit
structure of all major payer types including Medicare, Medicaid,
and private commercial -
- Knowledgeable and proficient in Claims billing procedures of
key payers as defined by plan -
- Keeps current with the requirements and eligibility criteria
for copay assistance from public, private and non-profit
organizations related to assigned programs in order to assist
customers with enrolling into third party financial assistance
opportunities when applicable. - -
- Coordinates the triage of patient, prescription and/or medical
orders to the appropriate partner for fulfillment or
administration. -
- Coordinates with board licensed healthcare professionals
including but not limited to 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, medical plans and third-party
financial assistance organizations for general information, status
updates and determination details within specified timeframes.
-
- Effectively explains approval or denial details with customers
in a manner that is easily understood to fit the needs of the
intended audience. - -
- Completes test claims or electronic verification of benefits
when applicable. -
- Maintains company, employee, and customer confidentiality as
well as compliance with all HIPAA regulations. -
- Accurately documents all customer communications in an
appropriate and professional manner within specified timeframes.
-
- Communicates customer statuses to the appropriate parties at
specified intervals or as needed. -
- Resolves customer issues through basic troubleshooting and
escalates potential problems or issues that require management's
attention in a timely manner. -
- Completes all the duties associated to the Enrollment and/or
Eligibility Specialist role when applicable or as assigned.
-
- Accurately collect the information required for each program
and capture the information in a Customer Relationship Management
system (CRM) or database. -
- Recruit and hire employees to support the organizational
structure of site to include onsite employees, telecommute, and
remote workforce -
You'll be rewarded and recognized for your performance in an
environment that will challenge you and give you clear direction on
what it takes to succeed in your role as well as provide
development for other roles you may be interested in. -
Required Qualifications:
- High school diploma / GED (or higher)
- 2+ years of hands-on Pharmacy Claims Processing, Benefit
Verification or Prior Authorization processing experience with a
hospital, medical or health service provider, PBM or payor -
-
- 2+ years of hands-on Pharmacy Claims Processing, Benefit
Verification or Prior Authorization processing experience
- Has been in a supervisory or lead role for 3 years -
- Specialty Pharmacy experience -
Telecommuting Requirements:
- Required to have a dedicated work area established that is
separated from other living areas and provides information
privacy
- Ability to keep all company sensitive documents secure (if
applicable)
- Must live in a location that can receive a UnitedHealth Group
approved high-speed internet connection or leverage an existing
high-speed internet service
Preferred Qualifications: -
- Associate's degree, -Medical Certification or equivalent
-
- 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 -
- Pharmacy Accreditation experience -
- Medical Billing/Coding experience -
- Previous work history working in a matrixed environment, call
center, operations environment -
Soft Skills:
- Demonstrated ability to provide quality customer service
-
- Strong knowledge of Internet navigation and research -
- Willingness to learn and grow in the position -
- Participate in continuous quality improvement activities
-
- Be a team player and collaborate across functions -
- Proven ability to set priorities and manage team to meet key
objectives of the business -
- Ability to manage more than one project or task at a time -
-
- Meet deadlines and proactively communicates roadblocks
-
- Speak, listen, and write in a clear, thorough, and timely
manner using appropriate and effective communication tools and
techniques -
- Strive for thoroughness and accuracy when completing tasks
-
- Ability to work independently - -
Careers with Optum. Our objective is to make health care simpler
and more effective for everyone. With our hands at work across all
aspects of health, you can play a role in creating a healthier
world, one insight, one connection and one person at a time. We
bring together some of the greatest minds and ideas to take health
care to its fullest potential, promoting health equity and
accessibility. Work with diverse, engaged and high-performing teams
to help solve important challenges.
California, Colorado, Connecticut, Nevada, Washington or New York,
Rhode Island Residents Only: The salary range for California /
Colorado / Connecticut / Nevada / Washington / New York / Rhode
Island residents is $67,800 - $133,100.Pay is based on several
factors including but not limited to education, work experience,
certifications, etc. In addition to your salary, UnitedHealth Group
offers benefits such as, a comprehensive benefits package,
incentive and recognition programs, equity stock purchase and 401k
contribution (all benefits are subject to eligibility
requirements). No matter where or when you begin a career with
UnitedHealth Group, you'll find a far-reaching choice of benefits
and incentives.
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an
Equal Employment Opportunity / Affirmative Action employer and all
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, age, national origin,
protected veteran status, disability status, sexual orientation,
gender identity or expression, marital status, genetic information,
or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
#RPO #YELLOW
Keywords: UnitedHealth Group, Orlando , Supervisor for Pharmacy Claims Prior Authorizations and Appeals - National Remote, Healthcare , Orlando, Florida
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