Healthcare Prior Authorization Specialist

1 week ago


Everett, Massachusetts, United States UnitedHealth Group Full time

About the Role:

The Prior Authorization Coordinator is a critical position within our team, responsible for reviewing and processing requests for prior authorization of medication in accordance with insurance provider guidelines. This role requires a solid understanding of healthcare insurance policies, pharmacy benefit management, and medical terminology.

Key Responsibilities:

  • Acquire and maintain a working knowledge of health plan formulary and authorization requirements
  • Utilize Cover My Meds system to facilitate faster turnaround time on a complete authorization
  • Gather necessary information from chart review to submit prior auth request to insurance providers
  • Act as a liaison between providers, pharmacy, health plans, and patients to support a timely medication authorization process
  • Communicate with providers, pharmacy, and patients to provide updates on the status of their prior auth request
  • Document in the patient electronic health record all medication authorization work provided following standard work guidelines
  • Provide and document in Epic medication authorization denials and health plan recommendation and or alternatives when provided
  • Ensure compliance with all relevant laws, regulations, and policies related to medication prior authorizations

Why Choose UnitedHealth Group?

At UnitedHealth Group, we offer a comprehensive benefits package, competitive pay, and opportunities for growth and development. Our team is dedicated to helping people live healthier lives and making the health system work better for everyone.

Requirements:

  • High School Diploma/GED (or higher)
  • Current certification from WA State Department of Health as a Certified Medical Assistant OR Licensed Pharmacy Technician
  • 1+ year(s) of experience with basic computer software and keyboarding
  • 6+ months of experience as a Pharmacy Technician or Medical Assistant


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