If you are located within 50 miles of 2 South Cascade Colorado Springs, CO, you will have the flexibility to telecommute* (work from home) 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 start Caring. Connecting. Growing together. 

This position is full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm MST. It may be necessary, given the business need, to work occasional overtime.  

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 

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 and practice guidelines set up by Optum and contracted payors
• 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 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

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 or equivalent years of experience
• 1 years of applied knowledge in managed care, healthcare, Medical/Dental office and/or Medical Insurance environment 
• 1 years of hands-on experience in computer data entry and telephone customer service
• Experience with Windows based programs including Microsoft Word
• Experience with Windows based programs including Microsoft Excel
• Experience with Windows based programs including Microsoft Outlook
• Working knowledge of medical terminology
• Must be 18 years of age OR older
• Ability to work full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm MST. It may be necessary, given the business need, to work occasional overtime.  

Preferred Qualifications

• Epic experience

Telecommuting Requirements:

• Reside within 50 miles of 2 South Cascade Colorado Springs, CO
• 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.

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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