Authorization and Pre-certification Coordinator
2 months ago
**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.**
This position is full-time, Monday - Friday. Employees are required to have flexibility to work any variable shifts based on the operating hours of 7:30 AM - 5:30 PM. It may be necessary, given the business need, to work occasional overtime. Our office is located at 2800 Marcus Ave, Ste 200, Lake Success, NY.
We offer 4 weeks of paid on-the-job training. The hours of the training will be aligned with your schedule from Monday - Friday.
**Primary Responsibilities**:
- Obtains insurance prior authorization for patient prescriptions, treatments, services, or procedures for new orders and re - authorization for additional units including performing any retro - authorization requests as allowed by payers; appeal prior authorization denials and help facilitate peer - to - peer reviews as needed Appropriately document authorization details in the patient’s medical record including notifying clinical staff of benefit limitations and authorization status
- Monitor pre - authorization denials for trends and provider documentation issues, and escalate to Lead or Supervisor as appropriate
- Meet or exceed productivity expectations after orientation period to ensure requests are being processed timely
- Escalate any issues or concerns to the appropriate department or manager as necessary
- Maintain strictest confidentiality
- Work on assigned projects as needed
- Perform other duties as assigned
- Obtain patient financial assistance
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
- 1+ years of experience in a medical billing office, medical office setting, OR insurance company, which includes processing claims and a working knowledge of CPT, ICD - 10, and HCPC coding
- Computer skills
- Customer service skills
- Flexibility to work any variable shifts based on the operating hours of 7:30 AM - 5:30 PM from Monday - Friday
- Must be 18 years of age OR older
**Preferred Qualifications**:
- Hematology / Oncology OR Primary Care experience
- Familiarity with payer authorization processes, including interfacing with payers via calls, fax, OR portals
- 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._
- 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._
**#RPO #RED
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