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Employees in this position will work as an extension of the local quality and provider teams by aligning to geographical regions, medical centers and / or physician practices that manage a high volume of UHC Medical & Retirement membership.
- Assisting in the review of medical records to highlight Star opportunities for the medical staff.
- Partner with your leadership team, the practice administrative or clinical staff to determine best strategies to support the practice and our members.
- Assist members in navigating their network of providers by assisting with follow-up and specialist appointments as needed.
- Assist with program eligibility and appropriate referrals to remove barriers in care. This may include referrals to case management and/or social worker services.
- Interaction with UHC members via telephone to assist and support an appropriate level of care. This may include making outbound calls to members and / or providers to assist in scheduling appointments, closing gaps in care or chart collection activities.
- Answer inbound calls from patients and / or providers regarding appointments.
- Communicate scheduling challenges or trends that may negatively impact quality outcomes.
- Activities may include data collection, data entry, quality monitoring, HQPAF submission and chart collection activities.
- Track appointments and document information completely and accurately in all currently supported systems in a timely manner.
- Demonstrate sensitivity to issues and show proactive behavior in addressing customer needs.
- Provide ongoing support and education to team members and assist in removing barriers in care.
- Optimize customer satisfaction, positively impact the closing of gaps in care and productivity.
- Locate medical screening results / documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of Clinical data and will be supervised by licensed and / or certified staff
- Manage time effectively to ensure productivity goals are met.
Ability to work independently in virtual setting.
- Ability to problem solve, use best professional judgment and apply critical thinking techniques to resolve issues as they arise.
- Identify and seek out opportunities within one’s own work flow to improve call efficiency.
- Adhere to corporate requirements related to industry regulations/responsibilities.
- Maintain confidentiality and adhere to HIPAA requirements.
- Other duties, as assigned.
High School Diploma / GED or higher
- 2+ years of telephonic customer service experience.
- 1+ years of a healthcare background with medical terminology familiarity of clinical issues.
- 1+ years of working experience with ICD- 9/10 and CPT Codes.
- 1+ years of working experience with Microsoft Tools: Word and Outlook.
- Experience with navigating, filtering and analyzing reports in Microsoft Excel.
- 1+ years of working experience with and knowledge of HIPAA compliance requirements.
- Strong data entry skills, with a typing speed of at least 45-50 WPM.
- Experience working in a Physician, Provider, and / or medical office is preferred.
- EMR and HEDIS knowledge and experience.
- Experience working as a Pharmacy Technician or CMA
- Medical coding certification is preferred.
- Demonstrated ability to identify with a consumer in order to understand and align with their needs and realities.
- Demonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect.
- Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s).
- Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
- Good Attendance Record.
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.
Keywords: pharmacy technician, CMA, medical adherence, CPT Codes, ICD-9, medical terminology