Senior Prior Authorization Configuration SME

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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.

As a Prior Authorization Configuration Audit SME/Prior Authorization Analyst, you will be vital to our success and drive quality and efficiency for Prior Authorization configuration and documentation. You will join a team that plays a vital role in ensuring we consistently meet and exceed market expectations for Prior Authorization requirements.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm local time. It may be necessary, given the business need, to work occasional overtime.

It may require different hours for 1st week of onboarding, training will be on the job Monday - Friday 8am - 5pm local time.

Primary Responsibilities:

• Serve as primary resource to identify and perform quality and audit opportunities within all tools and functions used for prior authorization configuration
• Work with SMEs and business partners as needed to confirm authorization rules
• Assist work received through inquiries or new requirement tickets and reporting for Quality results
• Assist with Authorization requirements configuration across systems and tools to be in accordance with source of truth
• Assist with creation and maintenance of process flows and other documentation to support configuration and audits
• Collaborate with other Configuration or Operational teams to support changes as needed
• Promote understanding of source of truth for authorization requirements across markets/payors.
• Create and maintain Standard Operating Procedures relative to Prior Authorization processes
• May work directly with auditors or on action plans and remediation
• Works with minimal guidance; seeks guidance only on complex tasks
• Provides explanations and information to teams, leadership and auditors
• Hosting and participating in meetings as a Subject Matter Expert
• Serves as a resource for those with less experience
• Other related job 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:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 1+ years of audit/quality experience
• 1+ years of experience facilitating meetings
• Experience with Prior Authorization requirements
• Benefit or Pricing experience in a claims processing system
• Writing and Executing queries in SQL server
• Knowledge of Applications such as Visio, Powerpoint and Access.
• Knowledge in use of Excel, Word and Teams
• Knowledge of HealthCare systems business end-to-end processes
• Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm local time. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• 1+ years working with Medicare, Medicaid or Commercial products
• 1+ years of experience documenting processes/SOP's
• Experience with claims operations, or benefit/Pricing configuration experience in the Facets claims processing system

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• 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

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $34.23 - $61.15 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

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