Prior Authorization Specialist - Golden, CO
Golden, CO 
Share
Posted Today
Job Description

Opportunities with New West Physicians.Bring your passion for health care to New West Physicians in Colorado, a team committed to providing excellent service to every patient... every time. We're not only one of the largest physician groups in Colorado with 21 offices throughout the Denver Metro area-we're also part of Optum, a nationwide family of over 53,000 dedicated physicians working together to help people live their healthiest lives. That means we're backed by the resources of a global health care organization working to help people live healthier lives and help make the health system work better for everyone. New West Physicians has received national awards for providing high quality health care in Colorado.It's all possible because of our highly qualified, board-certified family practice and internal medicine physicians, hospitalists, cardiologists, gastroenterologists, psychiatrists, endocrinologists, neurologists, physiatrists, physician assistants, nurse practitioners-and more. If this sounds like the place for you, it's time to take a closer look at New West Physicians and discover a path toyourlife's best work. (sm)

This position will process multi-practice requests for all services that require pre-authorization in a manner that ensures timeliness, accuracy, and maximum reimbursement.

Primary Responsibilities:

  • Receives, reviews and coordinates all information required to initiate a referral for pre-authorization for health care services for multiple practices.
  • Follows protocols set up by New West Physicians and contracted payors. Utilized New West Physicians Practice Guidelines as required.
  • Advises providers concerning the adequacy of the information contained in the referral. Makes suggestions within the protocols of the referral manual.
  • Maintains accurate documentation of the referral in the patient's medical record.
  • Maintains a communication log or tracking system for follow-up, data gathering and analysis.
  • Communicates to patients and providers in the referral network in a timely manner the status or completion of the referral and any information required to ensure continuity of care to the patient. Documents communication as required to ensure service excellence.
  • Maintains an effective working relationship with Medical Management staff of New West Physicians, with the office staff of referral providers, and with the office staff of contracted insurance companies. Documents communication as required to maintain service excellence.
  • Communicates in a timely manner to patient's primary care physician referrals that are denied or that require more information for approval.
  • Demonstrates critical thinking skills and effective communication skills in investigating breakdowns in the referral process to ensure positive working relationships with everyone involved.
  • Demonstrates excellent customer service skills: warm, respectful, gracious, and courteous in all communications. Notifies practice manager of referral breakdowns and patient complaints.
  • Educates patients and staff on changes in the referral process, alternatives available within the insurance plan and consequences of out-of-plan services.
  • Maintains knowledge base of service plan benefits, criteria for plan enrollment and eligibility time-frames, and resources available to the patient within the plan for information on plan services.
  • Other duties as assigned.

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:

  • At least two years in a health care setting
  • One year of applied knowledge in managed care, insurance, and medical terminology
  • One year of hands-on experience in computer data entry and telephone customer service
  • Ability to work independently in a fast-paced environment, to prioritize workload, and to communicate effectively with minimal supervision
  • Position requires sitting, standing and general movement throughout office
  • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role.
  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.

Preferred Qualifications:

  • Medical Assistant training and/or experience

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 doyour life's best work.(sm)

Colorado Residents Only: The hourly range for Colorado residents is $15.00 to $22.02. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity 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. Optum is a drug-free workplace. 2020 Optum. All rights reserved.

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
1+ years
Email this Job to Yourself or a Friend
Indicates required fields