Job Description

Role Purpose

The purpose of the role is to provide effective technical support to the process and actively resolve client issues directly or through timely escalation to meet process SLAs

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Purpose of Job: Positions in this function are responsible to determine if prior authorization is required and can be decisioned, or if it requires additional clinical review. Individuals support clinicians by contacting health providers and/or members to verify authorization or referral, setup cases, and document findings.

Positions in this function includes those responsible for initial triage of members, administrative intake of members and working with hospitals and the clinical team.

Primary Responsibilities:•

This is a production role and you will have the responsibility to meet production, quality, and regulatory expectations• Ensure case is set up correctly and document required information•

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

 As needed, make outbound calls to providers to coordinate provider availability in treating members• Other duties as assigned by manager and/or director.

Qualifications Required:

• Minimum of a High School Diploma / GED• 1+ years of professional experience in an office or healthcare environment

• Prior customer service experience making outbound calls•

Prior Work from home experience• Proficiency in using a computer

• 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)

• Flexibility to work outside standard hours of operations due to changing business needs• Ability to trouble shoot and setup computer equipment independently

• 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 UnitedHealth Group policies and standardsPreferred:

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

• 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 Services

• Professional experience in a Clerical or Administrative support related role

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• Purpose of Job: Positions in this function are responsible to determine if prior authorization is required and can be decisioned, or if it requires additional clinical review. Individuals support clinicians by contacting health providers and/or members to verify authorization or referral, setup cases, and document findings.

  Positions in this function includes those responsible for initial triage of members, administrative intake of members and working with hospitals and the clinical team.

  Primary Responsibilities:•

  This is a production role and you will have the responsibility to meet production, quality, and regulatory expectations• Ensure case is set up correctly and document required information•

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

   As needed, make outbound calls to providers to coordinate provider availability in treating members• Other duties as assigned by manager and/or director.

  Qualifications Required:

  • Minimum of a High School Diploma / GED• 1+ years of professional experience in an office or healthcare environment

  • Prior customer service experience making outbound calls•

  Prior Work from home experience• Proficiency in using a computer

  • 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)

  • Flexibility to work outside standard hours of operations due to changing business needs• Ability to trouble shoot and setup computer equipment independently

  • 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 UnitedHealth Group policies and standardsPreferred:

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

  • 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 Services

  • Professional experience in a Clerical or Administrative support related role

   

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• Build capability to ensure operational excellence and maintain superior customer service levels of the existing account/client
  • Undertake product trainings to stay current with product features, changes and updates
  • Enroll in product specific and any other trainings per client requirements/recommendations
  • Partner with team leaders to brainstorm and identify training themes and learning issues to better serve the client
  • Update job knowledge by participating in self learning opportunities and maintaining personal networks

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Deliver