Job title: Care Access Coordinator – National Remote
Company: UnitedHealth Group
Job description: 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.Optum Frontier Therapies has the vision that all people, no matter how unique, can access a better tomorrow.Focused on reimagining specialty pharmacy for patients with rare diseases and advanced therapeutics, we work a little harder. We aim a little higher. We expect more from ourselves and each other.Now we’re looking to reinforce our team with people who are decisive, brilliant – and built for speed.Come to Optum Frontier Therapies, part of UnitedHealth Group, and share your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.This position is full time, Monday – Friday. Employees are required to work our normal business hours of 8:00am – 9:00pm EST. It may be necessary, given the business need, to work occasional overtime.We offer 8 weeks of training (6 week-long virtual classroom training followed by peer shadowing for 2 additional weeks) during normal scheduled shift of Monday – Friday, 8:00 am – 9:00 pm ESTYou’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
- Serves as the Single Point of Contact (SPOC) for patient, caregivers, pharma, and providers.
- React with a professional and empathetic demeanor when addressing physician office and patients complaints and concerns.
- Demonstrates competency in using information technology, PCs and a variety of databases.
- Ability to comprehend and manage any problems that may arise. Using problem solving skills to produce an appropriate resolution for physician offices and patients.
- Maintains patient confidentiality and accurate documentation of calls to and from all parties.
- Knowledgeable and proficient in pharmacy benefit structure of all major payer types including government and commercial payers.
- Knowledgeable and proficient in the entire pharmacy prior authorization and appeals process for prescriptions medications.
- Navigate calls to pharmacy benefit manager to determine and obtain patient benefit structure details, initiate overrides, and obtain contracting requirements.
- Completes test claims or electronic verification of benefits when applicable.
- Accurately collect the information required for each program and capture the information in a Customer Relationship Management system (CRM) or database.
- Saturday delivery shipment tracking and logistics.
- Coordinates with board licensed healthcare professionals including nurses, pharmacists, or supervised pharmacy interns for information needed to complete Prior Authorizations, Appeals and third-party financial assistance forms.
- Follows up with pharmacy plans and third-party financial assistance organizations for general information, status updates and determination details within specified timeframes.
- Effectively explains prior authorization and appeal approval or denial details with customers in a way that is easily understood to fit the audience’s needs.
- Keeps current with the requirements and eligibility criteria for copay assistance from public, private, and non-profit organizations related to assigned programs to assist customers with enrolling into third party financial assistance opportunities when applicable
- This includes researching foundations available to support the patients’ holistic needs.
- Keeps current with existing treatment trends, treatment standards and updated indications related to assigned programs to complete Prior Authorization and Appeal forms.
- Maintains a working knowledge of program guidelines, FAQ’s, products, and therapeutic areas related to programs within the Frontier Therapies portfolio.
- Responsible for reviewing, interpreting and reacting to data provided by clients and customers.
- Coordinates the triage of patient prescription to the appropriate partner for fulfillment or administration.
- Communicates customer statuses to the appropriate parties at specified intervals or as needed.
- Resolve customer issues through basic troubleshooting and escalate potential problems or issues that require management’s attention in a timely manner.
- Maintains company, employee and customer confidentiality as well as compliance with all HIPAA regulations.
- Provide recommendations to IT partners on system enhancements to better drive performance and quality.
- Completes special duties or projects as assigned by leadership.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:
- High School Diploma / GED OR equivalent work experience
- Must be 18 years of age OR Older
- 5+ years of experience in Case/Account Management, Relationship Management, Customer Support or Professional Customer Service
- 2+ years of experience in Hands-on Pharmacy Claims Processing, Benefit Verification or Prior Authorization processing in an insurance or pharmacy setting
- Call Center environment experience
- Ability to work our normal business hours of 8:00am – 9:00pm EST. It may be necessary, given the business need, to work occasional overtime
Preferred Qualifications:
- Valid license, registration and/or certification, in good standing, to practice as a Pharmacy Technician as required by the Board of Pharmacy in the state employed
- Specialty Pharmacy experience
- Pharmacy Accreditation experience
- Previous work history working in a matrixed environment, call center, operations environment
- Bilingual in English and Spanish
- Experience with Pharmacy Claims Processing
Telecommuting Requirements:
- 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:
- Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures
- Ability to write reports, business correspondence, and procedure manuals
- Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public
- Ability to comprehend and apply principles of basic math while analyzing data and generating reports
- Ability to apply principles of logical thinking to a wide range of intellectual and practical problems
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyThe hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.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.#RPO
Expected salary: $19.86 – 38.85 per hour
Location: Dallas, TX
Job date: Fri, 25 Apr 2025 22:36:44 GMT
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