Prior Authorization Specialist - Augusta, Me

If you are located within a 1-hour commutable distance of Augusta, ME office, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

Opportunities at Change Healthcare , part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: Caring. Connecting. Growing together.

Prior Authorization Specialist staff maintain a detailed, demonstrated working knowledge of the process involved in submitting, receiving, and processing all aspects of a prior authorization requests. They will receive, review, and research, requests from community providers for prior authorization of medical supplies and services. They are responsible for processing PAs within the scope of an administrative assistant, triage the Medical and Dental Prior Authorization queues, and receive provider and client phone calls.

This position is full - time. Employees are required to work any shift between the hours of 7:30 AM - 4:30 PM EST (Eastern Standard Time zone) including the flexibility to work occasional overtime based on business need.

Our office is located at 45 COMMERCE DRIVE, SUITE 5, AUGUSTA, MAINE. Employees will be required to work 1 - 2 days onsite and some days from home.

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

Primary Responsibilities:

• Monitor electronic prior authorization queues: working prior authorization requests, based on SLA timelines, and make clinical and eligibility determinations
• Developing a working knowledge base of MaineCare policies, Industry best practice standards, and medical coding accuracy

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 higher)
• 1+ years of previous experience in an office OR call center setting
• 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.
• Ability to work any shift between the hours of 7:30 AM - 4:30 PM EST (Eastern Standard Time zone) including the flexibility to work occasional overtime based on business need

Preferred Qualifications:

• Some College (or higher)
• Previous experience in health care OR insurance office

Telecommuting Requirements:

• Reside within a 1-hour commutable distance of Augusta, ME office
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
• Ability to keep all company sensitive documents secure (if applicable)

Physical and Work Environment:

• Sitting, standing, walking, and using keyboard
• Office environment

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies required 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 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 OptumInsight . Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work. SM

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.

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

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