[Hiring] Access & Reimbursement Appeal Supervisor @UnitedHealth Group

Role Description

The Access & Reimbursement Appeal Supervisor in Optum Frontier Therapies will be on the team of an exciting new business serving patients with rare diseases, pharma manufacturers, and providers by dispensing and servicing therapies at the frontier of healthcare. This position requires a leader that can accurately provide directions, teach researching techniques, address and communicate medical and prescription insurance coverage requirements as well as a comprehensive knowledge of Medicare, Medicaid and commercial plan structures and standards.

• Supervision of access and reimbursement specialist and clinical team within the Optum Frontier portfolio.
• Direct oversight of team members that may work onsite or remotely across the country.
• Responsible for the initiation and ongoing follow up of all prior authorization, financial assistance and appeals processes.
• Triage prescriptions and medical orders to participating pharmacies and providers once all coverage obstacles have been resolved.
• Provide coaching, mentoring, and support in the development of staff.
• Recognize individual and team success that results in a high-level of team engagement and commitment.

Qualifications

• Active, unrestricted, pharmacist license.
• 3+ years of hands-on pharmacy prior authorization and appeals experience.
• 3+ years of experience performing clinical review and writing clinical criteria.
• 2+ years of hands-on Pharmacy Claims Processing, Benefit Verification or Prior Authorization, Appeals processing experience.
• 1+ years of experience in a supervisory or lead role.
• Specialty Pharmacy experience.
• Demonstrated ability to provide quality customer service.
• Ability to manage more than one project or task at a time.
• Meet deadlines and proactively communicate roadblocks.
• Ability to work independently.
• Willingness to learn and grow in the position.
• Team player and collaborate across functions.
• Proven ability to set priorities and manage team to meet key objectives of the business.

Requirements

• Focus on employee development and continuous coaching through monthly touch bases, performance scorecard reviews, and interim and annual performance evaluations.
• Manage employee schedules ensuring fair and consistent practices.
• Ensure policies and procedures are being followed.
• Work directly with training team to ensure all team members are trained to and compliant with policies and procedures and work instructions.
• Ensure team members remain compliant with all necessary licensure and continuing education requirements.
• Drive understanding of systems to partner with leadership on implementation teams.
• Monitor performance metrics and hold self and team members accountable to established productivity, quality, and service standards.
• Provide recommendations to IT partners on system enhancements to better drive performance and quality.
• Maintain a working knowledge of program guidelines, FAQ’s, products and therapeutic areas related to assigned programs.
• Coordinate the triage of patient, prescription and/or medical orders to the appropriate partner for fulfillment or administration.
• Follow up with pharmacy plans, medical plans and third-party financial assistance organizations for general information, status updates and determination details within specified timeframes.
• Accurately document all customer communications in an appropriate and professional manner within specified timeframes.
• Recruit and hire employees to support the organizational structure of site.

Benefits

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