Access & Reimbursement Specialist - National Remote
for headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We need to decide which sections have content.
From posting:
- Intro paragraph about Optum and mission: could be "About the role" maybe? Actually "About the role" could be description of role. The posting includes description: "The Access & Reimbursement Pharmacy Specialist will be responsible for the benefit verification research and benefit initiation of pharmacy claims..." That's role description. So we can put that under About the role
with
. - Responsibilities: there is a long list under "Primary Responsibilities". So we can have
Responsibilities
with- items.
- Requirements: there is "Required Qualifications" and "Preferred Qualifications". Could combine into Requirements? The instruction: Use headings for sections like Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We have both Required and Preferred qualifications. Could put under
Qualifications
with both required and preferred as list items? Or separate? Probably one Qualifications section. - Skills: there is "Soft Skills" list. So we can haveSkills
with- .
- Benefits: there is a section "What Are The Reasons To Consider Working For UnitedHealth Group?" with list of benefits. So we can have
- .
Qualifications: Required Qualifications and Preferred Qualifications.
Required:
- 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:
- 2+ years of Prior Authorization processing experience in an insurance or pharmacy setting
- Valid license, registration and/or certification, 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
We could combine under Qualifications heading with subheadings? But we only allowed headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We have Qualifications. Could we also have Requirements? The instruction says use headings for sections like Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we could have both Requirements and Qualifications sections. But we have Required and Preferred qualifications; maybe put Required under Requirements, Preferred under Qualifications? Or combine both under Qualifications. To be safe, we can have Requirements for required qualifications, and Qualifications for preferred qualifications. But the instruction says "Prefer a few substantive sections over many thin ones." Having both may be thin. However we have enough content for each. Let's decide: Use Requirements for required qualifications, Qualifications for preferred qualifications. That seems reasonable.
Skills: Soft Skills list:
- Ability to work independently and as a team, and maintain good judgment and accountability
- Demonstrated ability to work well with health care providers
- Meet deadlines and proactively communicates 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
- Ability to work independently
- 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
We'll put as
- .
Benefits: list from "What Are The Reasons To Consider Working For UnitedHealth Group?" includes:
- Competitive Base Pay
- a Full And Comprehensive Benefit Program
- Performance Rewards
- And a Management Team Who Demonstrates Their Commitment To Your Success.
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life & AD&D Insurance along with Short-term disability 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.)
We'll put each as
- . Note some are phrases; keep as is.
Pay: "The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment." Also "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)." Also "We comply with all minimum wage laws as applicable." We'll combine into a
. Schedule: "Ability to work 8-hour shifts Monday through Friday with a start time between 10:00am - 11:00am EST". Also maybe mention telecommute flexibility? That's in About the role. So schedule section just that. We must not include filler like "commensurate with experience". Not present. Now produce HTML fragment. We'll wrap sections in appropriate tags. Example:
About the role
...
Responsibilities
- ... ...
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
Qualifications
- 2+ years of Prior Authorization processing experience in an insurance or pharmacy setting
- Valid license, registration and/or certification, 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
Skills
- Ability to work independently and as a team, and maintain good judgment and accountability ...
Benefits
- . Note some are phrases; keep as is.
Pay: "The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment." Also "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)." Also "We comply with all minimum wage laws as applicable." We'll combine into a
Benefits
with- .
- Pay: there is "The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment." Also mention "Pay is based on several factors..." So we have pay info. So
Pay
with. - Schedule: there is "Ability to work 8-hour shifts Monday through Friday with a start time between 10:00am - 11:00am EST". That's schedule info. So
Schedule
with. We must not repeat job title as heading. No Job ID etc. Remove boilerplate: cookie/navigation/legal/EEO etc. Remove duplicated lines, application instructions. Also remove "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy." maybe not needed? It's not boilerplate but maybe part of responsibilities? Could be omitted? The instruction: remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The telecommuter policy is not exactly boilerplate but could be considered policy; but it's specific to role? Might keep? It's not a responsibility but a condition. Could be omitted as not substantive? Might keep under Responsibilities? Probably better to omit as it's policy. Also remove "Application Deadline: ..." etc. Remove EEO statements. Remove drug-free workplace etc. Remove #RPO #GREEN. We need to preserve all substantive information. So keep description, responsibilities, qualifications (required & preferred), skills, benefits, pay, schedule. We must not invent or summarize away detail. Must keep specifics. Let's extract content. About the role: The paragraph: "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. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Access & Reimbursement Pharmacy Specialist will be responsible for the benefit verification research and benefit initiation of pharmacy claims. To ultimately obtain patient access, the role includes ongoing follow up on prior authorizations and appeals. The role also includes identifying and obtaining financial assistance. This position is under direct supervision from the Access & Reimbursement Supervisor. This position 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." We can keep that as About the role. Responsibilities: list under "Primary Responsibilities". Let's capture each bullet: - 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 - 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 - 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 assigned by leadership We'll put each as
- .
Qualifications: Required Qualifications and Preferred Qualifications.
Required:
- 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:
- 2+ years of Prior Authorization processing experience in an insurance or pharmacy setting
- Valid license, registration and/or certification, 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
We could combine under Qualifications heading with subheadings? But we only allowed headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We have Qualifications. Could we also have Requirements? The instruction says use headings for sections like Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we could have both Requirements and Qualifications sections. But we have Required and Preferred qualifications; maybe put Required under Requirements, Preferred under Qualifications? Or combine both under Qualifications. To be safe, we can have Requirements for required qualifications, and Qualifications for preferred qualifications. But the instruction says "Prefer a few substantive sections over many thin ones." Having both may be thin. However we have enough content for each. Let's decide: Use Requirements for required qualifications, Qualifications for preferred qualifications. That seems reasonable.
Skills: Soft Skills list:
- Ability to work independently and as a team, and maintain good judgment and accountability
- Demonstrated ability to work well with health care providers
- Meet deadlines and proactively communicates 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
- Ability to work independently
- 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
We'll put as