Access & Reimbursement Specialist

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Access & Reimbursement Pharmacy Specialist will be responsible for the benefit verification research and benefit initiation of pharmacy claims. To ultimately obtain patient access, the role includes ongoing follow up on prior authorizations and appeals. The role also includes identifying and obtaining financial assistance. This position is under direct supervision from the Access & Reimbursement Supervisor. This position relies heavily on the ability to accurately follow directions, thoroughly research, address and communicate 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.

Knowledgeable and proficient in pharmacy benefit structure of all major payer types including government and commercial payers Knowledgeable and proficient in the entire pharmacy prior authorization and appeals process for prescriptions medications Navigate calls to pharmacy benefit manager to determine and obtain patient benefit structure details, initiate overrides, and obtain contracting requirements Completes test claims or electronic verification of benefits when applicable Accurately collect the information required for each program and capture the information in a Customer Relationship Management system (CRM) or database Coordinates with board licensed healthcare professionals including nurses, pharmacists, or supervised pharmacy interns for information needed to complete Prior Authorizations, Appeals and third-party financial assistance forms Follows up with pharmacy plans and third-party financial assistance organizations for general information, status updates and determination details within specified timeframes Effectively explains prior authorization and appeal approval or denial details with customers in a way that is easily understood to fit the audience's needs 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. This includes researching foundations available to support the patients' holistic needs Keeps current with existing treatment trends, treatment standards and updated indications related to assigned programs to complete Prior Authorization and Appeal forms Maintains a working knowledge of program guidelines, FAQ's, products, and therapeutic areas related to programs within the Frontier Therapies portfolio Responsible for reviewing, interpreting, and reacting to data provided by clients and customers Coordinates the triage of patient prescription to the appropriate partner for fulfillment or administration 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 Provide recommendations to IT partners on system enhancements to better drive performance and quality Completes special duties or projects assigned by