Explore opportunities at Atrius Health, part of the Optum family of businesses. We're an innovative health care leader and multi-specialty group practice, delivering an effective, connected system of care for adult and pediatric patients at 28 practice locations in eastern Massachusetts. Our entire team of providers (physicians, AP/NPs and ancillary clinicians) works collaboratively with a value-based philosophy within our group practice as well as with hospitals, rehab and nursing facilities. Be part of our vision to transform care and improve lives by building trust, understanding and shared decision-making with every patient. Join us and discover the meaning behind Caring. Connecting. Growing together.
Responsible for navigating requests for the prior authorization of medications not covered by a patient's insurance in accordance with insurance provider guidelines. Serves as an expert on subject matters for medication prior authorizations and maintains a solid understanding of healthcare insurance policies, drug information, pharmacy benefit management, and medical terminology.
Schedule: Monday - Friday, 8:30am - 5:00pm
Location: This role is Remote in Massachusetts.
If you reside in Massachusetts, you will have the flexibility to work remotely as you take on some tough challenges.
Primary Responsibilities:
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Responsible for communicating directly with patients, insurance companies, providers, clinical pharmacists and pharmacies to support timely review and processing of prior authorization requests for new and refill prescriptions
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Acquires and maintains a working knowledge of health plan formulary and authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization
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Develops proficiencies in utilization of Epic in accordance with department standard work guidelines
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Verifies patient's demographics, insurance eligibility and prescription benefit information required to process new and refill prescriptions, where permitted by state law
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Gathers all necessary information from chart review and identifies correct forms needed to submit prior authorization request to insurance providers
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Works as a patient advocate and functions as a liaison between the patient and payer to answer routine and complex inquiries, reimbursement questions, and avoid insurance delays
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Communicates with providers and patients to provide updates on the status of their prior authorizations or appeals
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Provides prompt feedback to physicians and management regarding issues with medication authorization denials and health plan recommendations and or alternatives when provided by the insurance company
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Assists patients with financial assistance for high copay medication utilizing manufacturer coupons, manufacturer patient assistance programs or provides patient with the appropriate Med Cost Savings Form and collaborates with Clinical Pharmacists as necessary
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Acquires and maintains a working knowledge of drug manufacturer patient assistance programs to include drug manufacturer coupons/vouchers and has knowledge of how to access them
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Ability to perform all tasks of a pharmacy care coordinator and other similar and related duties to assist with staff cross coverage as required or directed by the supervisor
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Provides superior phone services and quality customer service to ensure the highest level of patient satisfaction
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Interacts effectively and professionally with all patients, prescribers, payors, pharmacies and all location departments of Atrius Health
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Ability to work quickly and accurately on an independent basis with great attention to detail, and displaying initiative to quickly identify and resolve variances and discrepancies
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Follows all professional and departmental guidelines for PHI and HIPPA compliance and with all relevant laws, regulations, and policies related to medication prior authorizations
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Actively contributes to the evaluation and continuous improvement of the prior authorization process as well as department projects, prescription initiatives, policies, and procedures
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Complies with established departmental policies, procedures, and objectives
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Enhances professional growth and development through educational programs, seminars, etc.
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Follows all downtime and emergency processes per departmental policies
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Regular, reliable and predicable attendance is required
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
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Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
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Medical Plan options along with participation in a Health Spending Account or a Health Saving account
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Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
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401(k) Savings Plan, Employee Stock Purchase Plan
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Education Reimbursement
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Employee Discounts
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Employee Assistance Program
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Employee Referral Bonus Program
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Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
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High School Diploma/GED
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1+ years of Pharmacy Technician or prior authorization experience
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1+ years of experience using Microsoft systems
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Reside in Massachusetts
Preferred Qualifications:
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Bachelor's or Associate's degree in medical assisting or graduate of certificate program preferred with commensurate pharmacy experience and pharmacy knowledge
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Experience with Pharmacy management or EMR software and operational platforms
Soft Skills:
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Excellent attention to detail and strong organizational skills required
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Must demonstrate excellent customer service and communication skills as well as problem-solving abilities
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 hourly pay for this role will range from $18 - $32 per hour 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 make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is 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 is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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