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You're looking for the next great thing for your career. How about creating the future of health care? Optum Frontier Therapies is a new pharmacy services business pioneering a better approach to care for patients with rare diseases; we are on a mission to support people with compassion while creating access to therapies at the frontier of health care. With us, you'll find a fast-paced, passionate and professional culture where you can use your talent and our resources to make a huge impact—ensuring that all people, no matter how unique, have the ability to access a better tomorrow. Take this opportunity to start doing your life's best work.(sm) 

What makes your career greater with Optum Frontier Therapies? You'll work with expert and enthusiastic peers, be part of a culture focused on both clinical outcomes and business results, and contribute to a growing team that prides itself on learning, evolving and challenging the status quo.  

The Access & Reimbursement Specialist in Optum Frontier Therapies will be on the team of an exciting new business serving patients with rare diseases, pharma manufacturers, and providers by dispensing and servicing therapies at the frontier of healthcare.  As a new Optum business, we are building on our strengths but also challenging the status quo. We are creating a business that is designed to specifically serve the unique needs of rare disease patient populations and support the emerging therapies, which require enhanced services and new capabilities over traditional specialty pharmacies. Our mission, ‘supporting people with compassion while creating access to therapies at the frontier of health care,’ and vision, ‘that all people, no matter how unique, can access a better tomorrow’ are what drive and motivate us, as part of the larger UnitedHealth Group mission ‘to make the health system work better for everyone.’  

The Access & Reimbursement Specialist will be responsible for the initiation and ongoing follow up of all prior authorization, financial assistance and appeals processes within the Optum Frontier portfolio. Under direct supervision from the Access & Reimbursement Supervisor, the Specialist triages prescriptions and medical orders to participating pharmacies and providers once all coverage obstacles have been resolved. This position relies heavily on the ability to accurately follow directions, thoroughly research, address and communicate medical and 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.

Primary Responsibilities: 

• Maintains a working knowledge of program guidelines, FAQ’s, products and therapeutic areas related to assigned programs

• Responsible for reviewing, interpreting and reacting to data provided by clients and customers

• Knowledgeable and proficient in pharmacy and medical benefit structure of all major payer types including Medicare, Medicaid, and private commercial  

• Be knowledgeable and proficient in the entire prior authorization and appeals process for prescriptions medications, infusions, medical procedures and devices

• Navigate calls to pharmacy benefit manager and medical plans to determine and obtain patient benefit structure details, initiate overrides, obtain contracting requirements, and initiate Letter of Agreement if necessary 

• Follows up with pharmacy plans, medical plans and third-party financial assistance organizations for general information, status updates and determination details within specified timeframes

• Keeps current with existing treatment trends, treatment standards and updated indications related to assigned programs to complete Prior Authorization, Appeal forms, and to write letters of medical necessity when applicable

• Effectively explains prior authorization and appeal approval or denial details with customers in a manner that is easily understood to fit the needs of the intended audience

• Knowledgeable and proficient in Coding principles, including CPT and HCPCS   

• Knowledgeable and proficient in Claims billing procedures of key payers as defined by plan 

• Coordinates with board licensed healthcare professionals including but not limited to nurses, pharmacists, or supervised pharmacy interns for information needed to complete Prior Authorizations, Appeals and third-party financial assistance forms

• 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

• Coordinates the triage of patient, prescription and/or medical orders to the appropriate partner for fulfillment or administration

• Completes test claims or electronic verification of benefits when applicable

• Assists with researching foundations available to support the patients' holistic needs 

• Accurately documents all customer communications in an appropriate and professional manner within specified timeframes

• 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

• Completes all the duties associated with the Enrollment and/or Eligibility Specialist role when applicable or as assigned

• Accurately collect the information required for each program and capture the information in a Customer Relationship Management system (CRM) or database

• Provide recommendations to IT partners on system enhancements to better drive performance and quality  

• Completes special duties or projects as assigned by the Program Manager / Supervisor 

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:

• 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.)

• More information can be downloaded at: http://uhg.hr/uhgbenefits

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

Required Qualifications:

• High School Diploma/ GED (or higher) OR 4+ years of experience working as a Pharmacy Technician 

• 2+ years Pharmacy Claims Processing, Medical Billing/Coding, Benefit Verification OR Prior Authorization processing experience with a hospital, medical or health service provider, PBM or payor

Preferred Qualifications:

• Associate degree, Medical Certification or equivalent

• 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

Soft Skills:

• Demonstrated ability to provide quality customer service

• Ability to manage more than one project or task at a time

• 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

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

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 disease 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. 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $18.17 to $32.26. The salary range for Connecticut / Nevada residents is $20.00 to $35.53. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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 

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.

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