You will be reaching out to Dr Offices where you are requesting clinical information clarification, and case determination outcome. On average you will be making around 20 plus calls a day. After you gather the information you will be responsible for updating the system with all of the data gathered. You will also be responsible for documenting all calls and letter creation and system case updates. You must be able to navigate thru Excel and Word. This is a moderate case production level where you will be handling 30 plus cases a day. You will receive personal training and with the central training team which will consist of 90 day training period. Dress is business casual.
Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles.
- Respond to incoming provider and enrollee calls
- Resolve customer service inquiries which could include:
- Enter notifications, Providers status of an existing notification and determining if notification is required.
- Complete notification wizard along with ICD-9 and CPT coding
- Provide excellent customer service to both providers and enrollees
- Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.
- Assist with faxes and emails
- Strong experience with Microsoft office.
- Strong experience within insurance prior authorization and benefit review.
- Moderate work experience within own function.
- Some work is completed without established procedures.
- Basic tasks are completed without review by others.
- Supervision/guidance is required for higher level tasks.
- HS Diploma/GED
- 2+ years professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
- 2+ years professional experience do you have in clerical or administrator work
- 2+ years MS Office (Word, Excel and Outlook)
UnitedHealthcare , part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:
- Healthcare or insurance benefits
- Medical Terminology/Coding (ICD-9 and CPT)
- Call Center with high volume
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