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UnitedHealth Group Infusion - Prior Authorization Specialist- Worcester, MA in Worcester, Massachusetts

$1,000 sign on bonus

Full Time:

Reliant Medical Group is seeking a Infusion Prior Authorization Specialist.

Opportunities with Reliant Medical Group. When you join Reliant, you’ll be part of a community-based, multi-specialty, physician-led medical group. Everyone works collaboratively on a common purpose: improving the quality, cost and experience of health care. With the resources of a global health organization - Optum - behind us, we’re at the forefront of value-based care. Supported by a patient-centric business model - integrated care teams focus on the best patient care, rather than volume. Here, you’ll contribute to an exceptional patient experience. Discover a place where you can help shape the future of health care and do your life’s best work.(sm)

Position in this function works closely with the clinical staff and billing department. Ensure accurate, timely prior authorization from insurance carriers in order to optimize revenue. Collects demographic, insurance, and clinical information in order to ensure authorization is obtained prior to treatment being administered. Verifies insurance eligibility, benefits, prior authorization and researches denied services to ensure payments are processed on a timely basis. Acts as a liaison to ensure accurate processing of all claims.

Primary Responsibilities

  • Obtains prior authorizations for required clinic and infusion medications and works with patients to minimize financial barriers

  • Verify patient insurance benefits

  • Track patient referrals

  • Submit insurance authorizations

  • Works as a patient advocate and functions as a liaison between the patient and payer to answer routine and complex inquires, reimbursement questions and avoid insurance delays. Obtains insurance authorization and pre-certification for chemotherapy/infusion services

  • Researches additional or alternative resources for non-covered services to prevent payment denials. Familiarity with physician office billing and reimbursement, as well as medical and pharmacy benefits

  • Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding issues with non-covered drugs

  • Reports any problems, issues or payer trends, updates coding/payer guidelines for clinical staff.

  • Maintains a good working knowledge of both oncology and non-oncology authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Complies with patient confidentiality laws and regulations

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:

  • 1+ years of relevant work experience

  • Knowledge of Medical terminology, CPT and ICD codes and insurance billing background

  • Knowledge of oncology and infusion insurance benefits

  • Knowledge of various software applications such as Microsoft Word, Excel, Outlook, etc

  • Understanding of revenue cycle functions such as patient access, billing, payments, and denials. Ability to review data and provide the appropriate information to insurance companies in order to secure insurance authorization

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Solid ability to multi-task and cover for others within the department during absences

  • Ability to work independently and be comfortable talking with providers, staff, patients, and outside organizations

  • Ability to organize multiple activities and effectively handle a fast-paced, changing workload with daily deadlines

  • Demonstrated accuracy in record keeping and documentation with solid attention to detail

  • Excellent follow-up skills with the ability to handle multiple assignments simultaneously

  • Demonstrated good judgement as well as attention to detail while working well with a team

  • Excellent communication, organizational and interpersonal skills

Unless certification, licensure or registration is required, an equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed in this description, may be substituted for the above requirements.

Physical Requirements

  • Physical health sufficient to meet the ergonomic standards and demands of the position

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.