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
Access & Reimbursement Pharmacy Specialist will be responsible for the benefit verification research and benefit initiation of pharmacy claims. To ultimately obtain patient access the role includes ongoing follow up on prior authorizations and appeals. The role also includes identifying and obtaining financial assistance.
This position is under direct supervision from the Access & Reimbursement Supervisor This position relies heavily on the ability to accurately follow directions, thoroughly research, address and communicate prescription insurance coverage requirements as well as a comprehensive knowledge of Medicare, Medicaid and commercial plan structures and standards.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Knowledgeable and proficient in pharmacy benefit structure of all major payer types including government and commercial payers
- Knowledgeable and proficient in the entire pharmacy prior authorization and appeals process for prescriptions medications
- Navigate calls to pharmacy benefit manager to determine and obtain patient benefit structure details, initiate overrides, and obtain contracting requirements
- Completes test claims or electronic verification of benefits when applicable
- Accurately collect the information required for each program and capture the information in a Customer Relationship Management system (CRM) or database
- Coordinates with board licensed healthcare professionals including 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 and third-party financial assistance organizations for general information, status updates and determination details within specified timeframes
- Effectively explains prior authorization and appeal approval or denial details with customers in a way that is easily understood to fit the audience's needs
- Keeps current with the requirements and eligibility criteria for copay assistance from public, private, and non-profit organizations related to assigned programs to assist customers with enrolling into third party financial assistance opportunities when applicable. This includes researching foundations available to support the patients' holistic needs
- Keeps current with existing treatment trends, treatment standards and updated indications related to assigned programs to complete Prior Authorization and Appeal forms
- Maintains a working knowledge of program guidelines, FAQ’s, products, and therapeutic areas related to programs within the Frontier Therapies portfolio
- Responsible for reviewing, interpreting and reacting to data provided by clients and customers
- Coordinates the triage of patient prescription to the appropriate partner for fulfillment or administration
- Communicates customer statuses to the appropriate parties at specified intervals or as needed
- Resolve customer issues through basic troubleshooting and escalate potential problems or issues that require management’s attention in a timely manner
- Maintains company, employee and customer confidentiality as well as compliance with all HIPAA regulations
- Provide recommendations to IT partners on system enhancements to better drive performance and quality
- Completes special duties or projects 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
- Associate degree
- Retail Pharmacy experience
- Specialty Pharmacy experience
- Pharmacy Accreditation experience
- Proven work history working in a matrixed environment, call center, operations environment
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
California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The hourly range for this role is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
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.
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.
