Manage administrative intake of members Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review

The Release of Information Specialist (ROI Specialist) is responsible for processing all release of information (ROI) requests, specifically medical record, and billing requests, in a timely and efficient manner. This role must also ensure accuracy and provide clients and customers with the highest quality product and customer service. At all times, the ROI Specialist mus

75% Relationship development and educational meetings Develop relationships with local unions in the region through outbound calls and in person visits. Establish yourself as a strategic partner for Union Benefits. Schedule and deliver educational meetings to educate retirees and soon to be retirees about the UnitedHealthcare plans available through the Trust 20% Market a

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

Scan insurance cards, making sure that all paperwork is filled out correctly and signed Obtain consents signed by patients for procedures Collect copays and coinsurance, deductibles, and balances HPN eligibility for all health plan patients, new or follow ups. Update eligibility forms Document patients' charts when films and disks are brought to the office. Responsible fo

Responsible for accurately and professionally handling all front desk operations including answering phones, greeting patients, scheduling of all appointments, balancing daily collections, addressing routine inquiries, and forwarding non routine requests to appropriate personnel Assists with the inventory and maintenance of business office supplies and the completion of b

Provides clinical direction, administration and leadership for a field based Care Management team Monitors the performance of clinical staff to ensure standards and targets are being met Maintains master schedule of care management staff to ensure availability for all necessary direct care management functions as well as coordination of some after hours on call coverage W

Provide leadership and be accountable for the performance and direction of the services for the Optum client partnership, including Optum delivered managed services and strategic initiatives Partner with client executives and key stakeholders to develop and execute strategic plans that address client business needs (current and emerging), support growth, provide measurabl

Provides care coordination through physician practices for members to improve clinical quality and clinical documentation May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols May interact with members via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer

Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information Function as a member of a self directed team to meet specific individual and team performance metrics Telephonic discussion with health care providers and/or members to explain benefit covera

Act as a Subject Matter Expert for other team members Manage the intake of members or the admission/discharge information post notification Work with hospitals, clinics, facilities and the clinical team to manage requests for services Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census

Acts as a customer advocate to provide assistance, build and sustain positive relationships with brokers, their customer groups and dedicated employer groups through direct / indirect communication to resolve issues / problems Serve as the primary contact for the broker / customer / employer group for all service issues (benefits, enrollment, policies billing, eligibility

Perform research on various computer systems and document customer information regarding current status, payment expectations, notes of conversations and other relevant information Use mail, email and phones to contact customers to discuss, negotiate payment and resolve outstanding medical bill accounts and balances Obtain agreement on potential balance payoff and/or paym

Reponsible for 3 or more key tech capabilities tied lines of business customers Specializes in their customer centric area and acts as product owner in relation to the teams for that area Works with product manager and business to obtain voice of customer (VOC) and identify capabilities to add to the product Defines and provides direction for user experience and user inte

Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities Investigate and pursue recoveries and payables on subrogation claims and file management In