[Hiring] Referral and Prior Authorization Specialist @UnitedHealth Group

Role Description

This position is Remote in Oregon. If you are located within commutable distance to the office at 3680 NW Samaritan Drive, Corvallis, you will have the flexibility to work remotely as you take on some tough challenges.

The Prior-Authorization Specialist coordinates and facilitates the process of internal and external authorizations for patients of The Corvallis Clinic. This position is full-time, Monday - Friday. Employees are required to work during our normal business hours of 8:00am - 4:30pm PST. It may be necessary, given the business need, to work occasional overtime.

We provide up to 4 weeks of onsite training. Training will be held at 3680 NW Samaritan Drive, First Floor, Corvallis, OR 97330.

Primary Responsibilities:

• Participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlines in the Service and Behavioral Standards Handbook.
• Efficiently obtain all authorizations for medical procedures to be performed prior to patients scheduled date of service.
• Process authorizations and submit clinical supporting documentation to insurance carriers.
• Document all prior authorization information including approval dates and prior authorization number in patient chart.
• Read medical documentation and perform medical chart review prior to requesting authorization.
• Notify scheduling and clinical staff of delays in obtaining authorizations.
• Ensure that insurance carrier documentation requirements are met and authorization documentation is scanned and documented in the patient’s medical record.
• Complete follow-up as needed with physicians, clinical staff, and insurance companies.
• Monitor authorization requests to ensure timely processing and completion.
• Communicate approvals and denials to the ordering physician and assist with any denials or issues to resolve.
• Review denials and submit appeals if requested by physician.
• Research, correct, and re-submit rejected and denied claims.
• Inform supervisor about any changes or patterns when working denials of procedures.
• Collaborate with other departments to assist in obtaining pre-authorizations.
• Handle high workload volume timely and accurately.
• Perform other duties as assigned.

Qualifications

• High School Diploma/GED or equivalent years of work experience.
• Must be 18 years of age OR older.
• 2+ years of experience in a medical office.
• 2+ years of experience interacting with insurance companies.
• 2+ years of experience in ICD-10 and CPT coding knowledge.
• Computer proficiency (including Microsoft Outlook, Teams) and ability to use multiple web applications.
• Basic level of computer proficiency including Microsoft Word and Microsoft Excel.
• Ability to be on camera for meetings during work hours.
• Ability to work full-time, Monday - Friday.

Requirements

• Knowledge of anatomy and physiology (preferred).
• Knowledge of medical terminology (preferred).
• Reside within commutable distance to the office at 680 NW Samaritan Drive, Corvallis, OR 97330.
• Ability to keep all company sensitive documents secure.
• Required to have a dedicated work area established that is separated from other living areas.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection.

Soft Skills

• Strong communication and customer service skills both in person and via phone.
• Ability to work independently and maintain good judgment and accountability.
• Demonstrated ability to work well with others.
• Strong organizational and time management skills.
• Ability to multi-task and prioritize tasks to meet all deadlines.
• Ability to work well under pressure in a fast-paced environment.
• Excellent verbal and written communication skills.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (subject to eligibility requirements).