Job Description

Positions in this role determine whether prior authorization can be approved immediately or if further clinical review is necessary. These individuals assist clinicians by reaching out to healthcare providers and members to confirm authorizations or referrals, initiate cases, and record all relevant information. Roles in this function include those handling initial member triage, administrative intake, and collaboration with hospitals and clinical teams.

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Primary Responsibilities

 • This is a production role and you will have the responsibility to meet production, quality and regulatory expectation

 • Ensure case is set up correctly and document required informatio

 • Review, research and determine if case can be decisioned or if it requires additional clinical revie

 • Demonstrate proficiency and decision making by solving complex problems using available resources (documents, medical policy, standard operating procedure, etc.

 • As needed, make outbound calls to providers and/or members to obtain information regarding a cas

 • As needed, make outbound calls to providers to coordinate provider availability in treating member

 • Other duties as assigned by manager and/or director

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Qualifications Required:

• Minimum of a High School Diploma / GE

 • 1+ years of professional experience in an office or healthcare environmen

 • Prior customer service experience making outbound call

 • Proficiency in using a compute

 • Experience working with Microsoft Office Products including Microsoft Outlook (ability to create, edit, save, and send emails), Microsoft Word (ability to create, edit, save, and send documents), and Microsoft Excel (ability to create, edit, save, and send spreadsheets) • Ability to work an eight (8) hour shift Monday-Friday between 7am-7pm; Tuesday-Saturday or Sunday-Thursday shifts may be availabl

 • Flexibility to work outside standard hours of operations due to changing business need

 • Ability to trouble shoot and setup computer equipment independentl

 • Must have a designated work area established that is separate from other living areas and can be secured to maintain PHI or PI security in line with Wipro policies and standard

 • Must work at a designated approved UnitedHealth Group office or live in a location that can receive a dedicated hard-wired high-speed internet connection or leverage an existing high-speed internet service provider (ISP) (minimum speed 1.5 download mps and 1 upload mps). In areas where a Wipro approved ISP is not available, manager approval to leverage a local ISP and receive reimbursement for business utilization is required and available on exception basis only

Preferred:

• Previous experience working with back office medical platforms and/or authorizations system

 • Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and/or Medicaid Service

 • Professional experience in a Clerical or Administrative support related rol

 • Able to quickly learn various computer systems or applications 

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Soft Skills

 • Strong communication skills; Written and verba

 • Excellent critical thinking and problem - solving skill

 • Candidate needs to be highly organize

 • Analytical, problem solving and decision-making skills; ability to exercise good judgmen

 • Ability to prioritize work, handle multiple tasks and work independentl

 • Ability to focus and learn in a remote setting as an independent contributo

 • Strong attention to detail and maintaining quality focus and multi-tasking