Access & Reimbursement Specialist - National Remote

About the Role

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 inclusion, talented peers, comprehensive benefits, and career development opportunities.

This position is under direct supervision from the Access & Reimbursement Supervisor and relies heavily on the ability to accurately follow directions, thoroughly research, address, and communicate prescription insurance coverage requirements, as well as a comprehensive knowledge of Medicare, Medicaid, and commercial plan structures and standards. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Responsibilities

• 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 prescription medications
• Navigate calls to pharmacy benefit managers to determine and obtain patient benefit structure details, initiate overrides, and obtain contracting requirements
• Complete 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
• Coordinate 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
• Follow up with pharmacy plans and third-party financial assistance organizations for general information, status updates, and determination details within specified timeframes
• Effectively explain prior authorization and appeal approval or denial details with customers in a way that is easily understood to fit the audience's needs
• Keep 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, including researching foundations available to support patients' holistic needs
• Keep current with existing treatment trends, treatment standards, and updated indications related to assigned programs to complete Prior Authorization and Appeal forms
• Maintain a working knowledge of program guidelines, FAQs, 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
• Coordinate the triage of patient prescriptions to the appropriate partner for fulfillment or administration
• Communicate 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
• Maintain 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
• Complete special duties or projects assigned by leadership

Requirements

• 2+ years of hands-on Pharmacy Claims Processing experience and Benefit Verification in a pharmacy setting
• Ability to work 8-hour shifts Monday through Friday with a start time between 10:00am - 11:00am EST
• Must be 18 years of age or older

Preferred Qualifications

• 2+ years of Prior Authorization processing experience in an insurance or pharmacy setting
• 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, or operations environment

Skills

• Ability to work independently and as a team, and maintain good judgment and accountability
• Demonstrated ability to work well with healthcare providers
• Meet deadlines and proactively communicate roadblocks
• Speak, listen, and write in a clear, thorough, and timely manner using appropriate and effective communication tools and techniques
• Strive for thoroughness and accuracy when completing tasks
• Strong knowledge of Internet navigation and research
• Willingness to learn and grow in the position
• Participate in continuous quality improvement activities
• Be a team player and collaborate across functions
• Ability to multitask across different applications and work queues

Benefits

• Competitive base pay
• Paid Time Off accrued from the first pay period plus 8 paid holidays
• Medical plan options along with participation in a Health Spending Account or a Health Savings Account
• Dental, Vision, Life & AD&D Insurance along with Short-term and Long-Term Disability coverage
• 401(k) Savings Plan
• Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

Pay

The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment.

Schedule

• 8-hour shifts, Monday through Friday
• Start time between 10:00am - 11:00am EST