Remote Pharmacy Access & Reimbursement Specialist

Optum; Las Vegas (NV); On-site; USD 57,308,000 - 103,155,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

Dental, Vision, Life & AD&D

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Job summary

Optum is hiring an Access & Reimbursement Pharmacy Specialist. The role focuses on benefit verification, initiating prior authorizations, and pursuing patient access across Medicare, Medicaid, and commercial plans.

The position supports telecommuting from anywhere in the United States. You will research coverage requirements, communicate with pharmacy benefit managers, and assist patients with financial aid options.

Qualifications

• 2+ years of hands-on pharmacy claims processing experience.
• Experience with benefit verification and prior authorization processes.
• Ability to navigate pharmacy benefit managers and CMS/Medicare rules.

Responsibilities

• Research and verify patient benefits across major payer types.
• Initiate and manage prior authorizations and appeals.
• Coordinate with licensed professionals for information needed for approvals.
• Explain authorization results clearly to customers and document in CRM.
• Maintain HIPAA compliance and protect patient information.

Skills

Pharmacy claims

Benefit verification

Prior authorization

Pharmacy technician license

Education

Pharmacy technician license

Job description

Optum is hiring an Access & Reimbursement Pharmacy Specialist. The role focuses on benefit verification, initiating prior authorizations, and pursuing patient access across Medicare, Medicaid, and commercial plans.

The position supports telecommuting from anywhere in the United States. You will research coverage requirements, communicate with pharmacy benefit managers, and assist patients with financial aid options.