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 Access & Reimbursement Pharmacy Specialist is responsible for conducting benefit verification and initiating pharmacy claims to facilitate timely patient access to prescribed therapies. This role involves proactive follow-up on prior authorizations and appeals, as well as identifying and securing appropriate financial assistance resources.
Under the direct supervision of the Access & Reimbursement Supervisor, the specialist must demonstrate solid attention to detail, the ability to follow complex instructions accurately, and effective communication skills. Success in this role requires a thorough understanding of prescription insurance coverage requirements and a comprehensive knowledge of Medicare, Medicaid, and commercial insurance plan structures and standards.
Full-time position / 40 hours per week / 8:30 am - 5:00 pm
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Demonstrate expertise in pharmacy benefit structures across government and commercial payers
Manage the full lifecycle of pharmacy prior authorizations and appeals
Communicate with pharmacy benefit managers to verify benefits, initiate overrides, and clarify contracting requirements
Perform electronic benefit verifications and test claims as needed
Accurately document case details in CRM systems
Collaborate with licensed healthcare professionals to complete necessary documentation for authorizations, appeals, and financial assistance
Conduct timely follow-ups with payers and assistance programs to obtain status updates and determinations
Clearly explain benefit decisions and next steps to patients and providers
Stay current on copay assistance eligibility and available third-party financial resources
Maintain up-to-date knowledge of treatment guidelines and product indications relevant to assigned programs
Interpret and act on client and customer data to support program success
Coordinate prescription fulfillment or administration with appropriate partners
Provide regular status updates to stakeholders and escalate issues as needed
Ensure compliance with HIPAA and confidentiality standards
Recommend system enhancements to improve performance and quality
Support special projects and tasks as assigned by leadership
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:
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
2+ years of hands-on Pharmacy Claims Processing, Benefit Verification or Prior Authorization processing in an insurance or pharmacy setting
Preferred Qualifications:
Specialty Pharmacy experience
Previous work history working in a matrixed environment, call center, operations environment
Reside within the Mountain or Pacific Time Zones
Soft Skills:
Demonstrated ability to provide quality customer service
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
Solid 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
Optum Frontier Therapies has the vision that all people, no matter how unique, can access a better tomorrow.
Focused on reimagining specialty pharmacy for patients with rare disease and advanced therapeutics, we work a little harder. We aim a little higher. We expect more from ourselves and each other.
Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.
Come to Optum Frontier Therapies, part of UnitedHealth Group, and share your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
