[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, OR 97330, 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. Monday – Friday 8:00am - 4:30pm PST. 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 consistent with the Service and Behavioral Standards Handbook.
• Efficiently obtain all authorizations for medical procedures 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 numbers in patient charts.
• Read medical documentation and conduct medical chart reviews 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.
• 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 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 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.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• Salary range from $18 - $32 hourly based on full-time employment.