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Optum · 1 day ago

Access & Reimbursement Specialist

United States

Full-time

Remote

Mid Level

$20.38/hr - $36.44/hr

3+ years exp

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Access & Reimbursement Pharmacy Specialist will be responsible for benefit verification research, initiation of pharmacy claims, and ensuring patient access through follow-ups on prior authorizations and appeals.

EducationHealth CareMedicalPharmaceutical

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

Qualification

Prior Authorization processingPharmacy Claims ProcessingBenefit VerificationPharmacy Technician certificationSpecialty Pharmacy experiencePharmacy Accreditation experienceCustomer Relationship Management (CRM)Internet navigationCommunication skillsTeam collaboration

Required

3+ years of Prior Authorization processing experience in an insurance or pharmacy setting

2+ years of hands-on Pharmacy Claims Processing experience and/or Benefit Verification in an insurance or pharmacy setting

Ability to work 8-hour shifts Monday through Friday with a start time between 10:00am-11:00am EST

Must be 18 years of age OR older

Preferred

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

Specialty Pharmacy experience

Pharmacy Accreditation experience

Previous work history working in a matrixed environment, call center, operations environment

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Company

Optum

Glassdoor3.6

Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.

Founded in 2011

Eden Prairie, Minnesota, USA

10001+ employees