Referral and Prior Authorization Specialist

UnitedHealth Group; United States; Hybrid; USD 25,000 - 44,000; Full time

Job summary

UnitedHealth Group in Oregon is seeking a full-time professional to manage prior authorizations for medical procedures. The role involves obtaining authorizations, documenting in patient charts, and coordinating with physicians, staff, and insurance carriers.

Responsibilities include reviewing medical records, ensuring complete information, and handling denials or appeals with thorough communication to clinicians. Remote work options with onsite training are offered.

Qualifications

• 1+ years of experience working with Medical Prior Authorizations
• 2+ years of experience in a medical office
• 1+ years of experience interacting with insurance companies
• 1+ years of experience in ICD-10 and CPT coding knowledge

Responsibilities

• Obtain authorizations for procedures prior to patient date of service
• Process authorizations and submit documentation to insurance carriers
• Document all prior authorization information in patient chart
• Notify scheduling and clinical staff of delays in obtaining authorizations
• Ensure authorization documentation is scanned and kept in medical records
• Communicate approvals/denials to ordering physician and assist with any denials or issues

Skills

Strong communication

Customer service

Time management

Multi-tasking

Education

High School Diploma/GED

Tools

Microsoft Outlook

Microsoft Teams

Microsoft Word

Microsoft Excel

Job description

This position is Remote in Oregon. If you are located within commutable distance to the office at 3680 NW Samaritan Drive Corvallis, OR 97330, you will have the flexibility to work remotely* as you take on some tough challenges.

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make 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.

Join us to start Caring. Connecting. Growing together.

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. Monday - Friday 8:00am - 4:30pm PST. Training will be held at 3680 NW Samaritan Drive, First Floor, Corvallis, OR 97330.

Primary Responsibilities:

• Will participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlines in the Service and Behavioral Standards Handbook. To this end, employee will be expected to read, have familiarity, and embrace the principles contained within
• Efficiently obtains all authorizations for medical procedures to be performed prior to patients scheduled date of service
• Processes authorizations and submit clinical supporting documentation to insurance carriers
• Documents all prior authorization information including approval dates, prior authorization number in patient chart
• Reads medical documentation and does medical chart review prior to requesting authorization. Reviews the medical records, diagnosis and laboratory reports. Reviews accuracy and completeness of information requested and ensures that all supporting documents are present
• Notifies scheduling and clinical staff of delays in obtaining these authorizations
• Ensures that insurance carrier documentation requirements are met and authorization documentation is scanned and documented in the patient's medical record. Reviews order to determine if testing will warrant obtaining an authorization or if the testing is a covered benefit not requiring an authorization through the patient's insurance coverage. Maintains timely communication with ordering physicians and clinical staff when missing information has not been received
• Completes follow-up as needed with physicians, clinical staff, and insurance companies
• Monitors authorization requests to ensure timely processing and completion
• Communicates approvals and denials to the ordering physician and assists with any denials or issues to resolve
• Reviews denials and submits appeals if requested by physician in an effort to obtain approval by insurance companies
• Researches, corrects, and re-submits rejected and denied claims. Prepares reconsiderations and works with the billing staff if the denial need to go to an appeals level
• Informs supervisor about any changes or patterns when working denials of procedures
• Collaborates with other departments to assist in obtaining pre-authorizations in a cross-functional manner
• Ability to handle high workload volume timely and accurately
• Performs other duties as assigned

Required Qualifications:

• High School Diploma/GED or equivalent years or work experience
• Must be 18 years of age OR older
• 1+ years of experience working with Medical Prior Authorizations
• 2+ years of experience in a medical office
• 1+ years of experience interacting with insurance companies
• 1+ years of experience in ICD-10 and CPT coding knowledge
• Computer proficiency (including Microsoft Outlook, Microsoft Teams) and be able to use multiple web applications
• Basic level of computer proficiency including Microsoft Word (create, edit, save) and Microsoft Excel (create, sort, view, filter)
• Ability to be on camera for meetings during work hours
• Ability to work 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

Preferred Qualifications:

• Knowledge of anatomy and physiology
• Knowledge of medical terminology

Telecommuting Requirements:

• Reside within commutable distance to the office at Reside within a commutable distance to 3680 NW Samaritan Drive Corvallis, OR 97330
• Ability to keep all 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 UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

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; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

*All employees working remotely 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 salary for this role will range from $18 - $32 hourly based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.