Financial Clearance Representative Associate, Retail Pharmacy Prior Authorization

Opportunities At Optum

As an Optum employee, you will provide support to the Allina Health account. 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.

Job Summary

Responsible for completing the financial clearance process and creating the first impression of Optum services to patients, their families, and other external customers. You will articulate information in a manner that patients, guarantors, and family members understand and will know what to expect regarding their financial responsibilities. Work with medical staff, nursing, ancillary departments, insurance payers, and other external sources to assist families in obtaining healthcare and financial services.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Verify insurance eligibility and completes automated insurance eligibility verification, when applicable and appropriately documents information in Epic
• Confirm that a patient's health insurance(s) is active and covers the patient's medication
• Review and analyze patient visit information to determine whether authorization is needed and understands payor specific criteria to appropriately secure authorization and clear the account prior to service where possible
• Ensure that initial and all subsequent authorizations are obtained in a timely manner
• May provide mentoring to less experienced team members on all aspects of the revenue cycle, payer issues, policy issues, or anything that impacts their role
• Initiating prior authorizations for medications

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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
• 6+ months of experience with insurance and pharmacy benefit verification, pre-experience with prior authorization activities in healthcare business office/insurance operations
• 6+ months of experience using basic retail medication knowledge
• Intermediate level of proficiency with Microsoft Office products
• Must be 18 years of age OR older

Preferred Qualifications

• Associate degree or Vocational degree in Business Administration, Health Care Administration, Public Health, or Related Field of Study
• Experience working with clinical staff
• Previous experience working in outpatient and/or inpatient healthcare settings
• Experience working in clinical documentation
• Previous experience working with a patient's clinical medical record
• Retail pharmacy experience
• EPIC experience
• Payer portals and/or covermymeds experience
• CphT or CMA certification

Soft Skills

• Excellent customer service skills
• Excellent written and verbal communication skills
• Demonstrated ability to work in fast paced environments

*All Telecommuters 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 $16.00 to $29.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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 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.

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