Job Description

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.

Position is for outbound call center with a strong background in data entry. Requires someone who is meticulous especially with document review. Healthcare claims review, medical billing or prior authorization experience preferred.

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Primary Responsibilities:

• 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

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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

• 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)

• Ability to work an eight (8) hour shift Monday-Friday between 7am-7pm; Tuesday-Saturday or Sunday-Thursday shifts may be available

• 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 standards

• Remote but MUST 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).