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 start Caring. Connecting. Growing together.
This position will process multi-practice requests for all services that require referrals and pre-authorization in a manner that ensures timeliness, accuracy, and maximum reimbursement.
This position is full time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am – 5:00 pm MST. It may be necessary, given the business need, to work occasional overtime.
We offer 4 weeks of on-the-job training. The hours of the training will be aligned with your schedule.
If you are located in the state of Colorado, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Receives, reviews, and coordinates all information required to initiate a referral for pre-authorization for health care services for multiple practices.
- Follows protocols set up by New West Physicians/Optum and contracted payors. Utilized New West Physicians/Optum Practice Guidelines as required.
- Advises providers concerning the adequacy of the information contained in the referral. Makes suggestions within the protocols of the referral manual.
- Maintains accurate documentation of the referral in the patient’s medical record.
- Maintains a communication log or tracking system for follow-up, data gathering and analysis.
- Communicates to patients and providers in the referral network in a timely manner the status or completion of the referral and any information required to ensure continuity of care to the patient. Documents communication as required to ensure service excellence.
- Maintains an effective working relationship with Medical Management staff of New West Physicians/Optum, with the office staff of referral providers, and with the office staff of contracted insurance companies. Documents communication as required to maintain service excellence.
- Communicates in a timely manner to patient’s primary care physician referrals that are denied or that require more information for approval.
- Demonstrates critical thinking skills and effective communication skills in investigating breakdowns in the referral process to ensure positive working relationships with everyone involved.
- Demonstrates excellent customer service skills: warm, respectful, gracious, and courteous in all communications. Notifies practice manager of referral breakdowns and patient complaints.
- Educates patients and staff on changes in the referral process, alternatives available within the insurance plan and consequences of out-of-plan services
- Maintains knowledge base of service plan benefits, criteria for plan enrollment and eligibility timeframes, and resources available to the patient within the plan for information on plan services.
- Other duties as assigned.
- HIPAA Security Level: High access to systems/patient information.
- Supervisory Duties: None.
- Work Environment/Schedule: Telecommuter, first 90 days probation period training can be done in office or through Microsoft teams.
- Full time Monday thru Friday 8am -5pm.
You’ll 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
- 1+ years of hands-on experience in computer data entry and telephone customer service
- A strong working knowledge of medical terminology.
- Knowledge of Insurance portals
- Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm MST. It may be necessary, given the business need, to work occasional overtime
Telecommuting Requirements:
- Reside within the state of Colorado
- 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.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Colorado, Residents Only: The hourly range for this role is $16.00 to $28.27 per hour. Pay is based on several factors including but not limited to local 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, you’ll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves 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.
