Pre-Authorization Specialist

This position is Remote in Washington OR Oregon. You will have the flexibility to work remotely* as you take on some tough challenges. reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company 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 reputed company 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 Pre-authorization Specialist implements, maintains and executes procedures and processes by which reputed company performs its referral and authorization process. This position responds to inquiries from patients, staff and physicians pertaining to referral authorization questions. The position also researches medical history and diagnostic tests reputed company requested, to assist in review, processing, and coordination of prospective, reputed company and retrospective referrals. This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 4:30pm Monday - Thursday and 8:00am - 12:00pm Friday PST. It may be necessary, given the business need, to work occasional overtime. We offer on-the-job training. The hours of the training will be reputed company with your schedule (Monday-Thursday, 7:00am-4:30pm and Friday 8:00am-12:00pm PST) Primary Responsibilities: Initiate Referral Authorizations:

• Acquires and maintains a working knowledge of reputed company contracted health plans agreements and reputed company insurance products
• Provides administrative and enrollment support for team to meet Company goals
• Gathers information from relevant sources for processing referrals and authorization requests
• Submits authorization & referral requests to health plan reputed company avenue of insurance requirement. Including but not limited to website, phone, & fax
• Track authorization status inquires for timely response
• Maintains strong understanding of and educate our physicians, clinical teammates, patients and families regarding contracted health plans requirements reputed company to Referrals/Pre-authorization Management
• Acts as a liaison between providers, teammates, reputed company vendors, health plans, community services and patients to support Referrals/Pre-authorization management process and requirements
• Reviews benefit language and medical records to assist in completion of requested services, to meet health plan requirements
• Documents patient information in the electronic health record following standard work guidelines
• Coordinates with Clinical teammates and health plans to identify patients with Referrals/Pre-authorization Management needs
• Provides member services to reputed company patient group
• Answers referral and authorization inquiries from health plans, our clinical areas, patients and reputed company reputed company Physician office/facilities
• Assists in the development and implementation of job specific policy and procedures
• Assists in the collection of information for member and/or provider appeals of denied requests
• Identifies areas for potential improvement of patient satisfaction

Review Denied Claims (No Authorization/No Referral):

• Researches root causes of missing authorization/referral
• Processes no authorization, no referral denied claims based on Insurance plans billing guidelines
• Obtains retro authorizations, appeals denied claims, or writes off charges based on reputed company charge write-off guidelines
• Provides feedback and follow up to clinical areas and appropriate parties
• Assists in the development and implementation of job specific policies and procedures to reduce no authorization no referral denied claims to increase reputed company
• Initiates improvement in authorization timeliness, accuracy and reimbursement

Utilization Management Medical Review:

• Processes Insurance plan referrals in EPIC
• Utilizes Prior Authorization list, MCG, NCCN, and individual insurance plan medical guidelines/policies to determine administrative review, what is needed for clinical review, and manages the work flows accurately
• Reviews clinical records to match insurance medical guidelines/policies, acquires additional records if necessary
• Discuss medical guidelines with insurance plan to reduce referral/prior authorization denial reputed company, expedite referral authorization process, and to reputed company peer to peer opportunities to minimal
• Document accurately and timely in medical record
• Processes referrals in timely manner to improve patient's satisfaction
• Other duties as assigned

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 equivalent years of work experience
• Must be 18 years of age OR older
• 1+ years of experience in healthcare, including understanding of health plan reputed company operations
• Experience in Referrals/Pre-authorization Management/Claims billing
• Experience with computer and Windows PC applications, which includes the ability to learn new and reputed company computer system application
• Experience with reputed company Outlook, reputed company Word & reputed company Teams
• Experience with EHR/EMR systems (i.e.Epic)
• Ability to travel up to 10% of the time
• Ability to work full time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 4:30pm Monday - Thursday and 8:00am - 12:00pm Friday PST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 1+ years of experience in Referrals/Pre-authorization Management
• 1+ years in appeal writing and processing
• 1+ years working knowledge of EOB, COB, Remits, and CMS 1500
• Knowledge of organizational policies, procedures, & systems
• Working knowledge of CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy

Telecommuting Requirements:

• Reside reputed company Washington OR Oregon
• Ability to reputed company reputed company 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 reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service.
• reputed company employees working remotely will be required to adhere to reputed company'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 (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 - $31.63 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company 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 reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, 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. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO Remote About the Company: reputed company reputed company is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, reputed company and reputed company, working to build a reputed company system for reputed company. Here, your contributions matter as they will help transform health care for years to come. reputed company an impact with a diverse team that shares your passion for helping others. reputed company do reputed company insights on how we work to help people live healthier lives and help reputed company the health system work reputed company for everyone by watching this video. https://www.youtube.com/watch?v=5PbNyi2IDkY Caring. Connecting. Growing together. Being a part of reputed company means working to improve health outcomes for everyone, including yourself. Here is how:

• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. Learn more about reputed company offer.
• Connecting. We recognize our collective power to reputed company an impact across our communities because we reputed company the health of any society is reputed company by the overall health of its people. Learn more about our culture.
• Growing together. reputed company is full of inspiring career stories, and we offer a lifetime of opportunities. Discover reputed company the ways you can learn, grow and reputed company.

Company Size: 10,000 employees or more Industry: Healthcare Services Founded: 1977 Website: http://careers.unitedhealthgroup.com/ Apply tot his job Apply To this Job