Acquires and maintain a working knowledge of Optum contracted health plans agreements and related insurance products Provides administrative and enrollment support for team to meet Company goals Gathers information from relevant sources for processing referrals and authorization requests Submits authorization & referral requests to health plan via avenue of insurance requirement. Including but not limited to website, phone, & fax Track authorization status inquires for timely response Maintains ... more details
If you are within a commutable distance of 1901 North Solar Drive, Suite 245, Oxnard, CA, you will have the flexibility to work from home and the office in this hybrid role* 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to startCaring. Connecting. Growing together.
This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM PST. It may be necessary, given the business need, to work occasional overtime.
Our office is located at 1901 North Solar Drive, Suite 245, Oxnard, CA. Employees will be required to work some days onsite and some days from home.
We offer 4 weeks of paid training. The hours during training will be 8:00 AM - 5:00 PM PST from Monday - Friday. Training will be conducted on - site.
*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.
Primary Responsibilities:
- Acquires and maintain a working knowledge of Optum contracted health plans agreements and related insurance products
- Provides administrative and enrollment support for team to meet Company goals
- Gathers information from relevant sources for processing referrals and authorization requests
- Submits authorization & referral requests to health plan via avenue of insurance requirement. Including but not limited to website, phone, & fax
- Track authorization status inquires for timely response
- Maintains understanding of and educate our physicians, clinical teammates, patients and families regarding contracted health plans requirements related to Utilization Management and authorizations
- Acts as a liaison between providers, teammates, outside vendors, health plans, community services and patients to support Utilization Management process and requirements
- Reviews benefit language and medical records to assist in completion of requested services, to meet health plan requirements
- Documents patient information in the electronic health record following standard work guidelines
- Coordinates with Clinical teammates and health plans to identify patients with Utilization Management needs
- Provides member services to all patient group
- Answers referral and authorization inquiries from health plans, our clinical areas, patients and outside Optum Physician office / facilities
- Assists in the development and implementation of job specific policy and procedures
- Assists in the collection of information for member and / or provider appeals of denied requests
- Identifies areas for potential improvement of patient satisfaction
- Researches root causes of missing authorization / referral
- Processes no authorization, no referral denied claims based on Insurance plans billing guidelines
- Obtains retro authorizations, appeals denied claims, or writes off charges based on Optum charge write - off guidelines
- Provides feedback and follow up to clinical areas and appropriate parties
- Assists in the development and implementation of job specific policies and procedures to reduce no authorization no referral denied claims to increase revenue
- Initiates improvement in authorization timeliness, accuracy and reimbursement
Youll 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
- Must be 18 years of age OR older
- 2+ years of experience in healthcare
- Ability to work any shift between the hours of 8:00 AM - 5:00 PM PST from Monday - Friday including the flexibility to work occasional overtime based on business need
Preferred Qualifications:
- 2+ years of office experience in the healthcare industry at the corporate level
- Certified Professional Coder (CPC) OR equivalent
- Experience in Utilization Management
- Intermediate level of experience with Microsoft Suite
Telecommuting Requirements:
- Reside within a commutable distance of 1901 North Solar Drive, Suite 245, Oxnard, CA
- 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
California Residents Only: The hourly range for this is $16.54 - $32.55 per hour. Pay is based on several factors including but not limited tolocal labor markets, education, work experience, certifications, etc.UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location, and incomedeserves 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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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