Position Description:

You will be writing denial letter using templates, following contractual requirements. This is a production environment, heave cases load. You must be flexible to take on other task, with minimum phone time. There will no member or patient contact. Team size - National _ 100+ in office position, dress code  is business casual, Personality that best succeed in this role is heads down, focused, self-motivated, adaptable to change. team player. Me be able to create denial letter using templates and proofread for errors.

When you are in the business of health care, you're in the business of people. At UnitedHealth Group we want every customer experience to be distinctly personal. The challenge is complex. When people call us for help, their focus is on getting the best care possible. We help them understand their benefits and their options. This part of their lives matters a lot to them and it matters just as much to us. Our customer service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care.

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.

Primary Responsibilities:

• Answer inbound calls in call center and document all calls
• Make outbound calls to enroll members into Wellness programs
• Schedule appointments
• Collaborate with wellness Coaches and Nurses
• Follows department Standard Operating Procedures for handling of cases
• Uses appropriate template
• Prints/faxes letters
• Converts to Adobe for saving
• Updates database
• Able to work independently without being constantly monitored.
• Acts as a problem solver and resource for the team.
• Able to successfully handle complex case process issues with minimal direction/reliance from sup/mgr
• Able to assist other team members with complex cases
• Assist with Audit prep
• Assist with special projects if asked
• Considered SME in multiple state requirements and LOBs (seen as 'go to' person by sups, mgrs, or other team members in these multiple areas).
• Individual audit scores consistently exceed 98% overall.
• Knowledge/skill set is utilized as trainer to other staff for department systems/processes
• Understands multiple systems and how they work (e.g., how to create new IDT, how to fix Adobe issue, how to desktop share, etc.) and acts as a resource to the team.
• Available for help with UAT testing of new systems.
• Effectively problem solves complex cases, processes, etc and performs independent assessment of concerns.
• Is able to resolve cases on their own and rarely needs assistance from supv/mgr
• Able to identify and address all issues in case w/out prompting or oversight (e.g., comfortable creating accurate and complete responses to complex issues).
• Reaches out to other areas to make sure issues are fully resolved.
• Works effectively with other team members to facilitate timely review and closure of cases
• Comes to the table with a solution, not just a problem
• Utilizes time management skills to successfully prioritize work load to meet established TAT.
• Assists in training and training documents.
• Participates in team meetings.
• Understands State regulations/contractual requirements:
• Timeframes
• Reading grade levels
• Template requirements
• State Meetings as required
• Assists in branding and template revisions
• Ensure notification requests are cleared out of the queues timely.
• Initiation and distribution of helpdesk ticket information for IT issues that affect team as whole and not individuals.
• Extensive work experience within own function.
• Work is frequently completed without established procedures.
• Works independently.
• May act as a resource for others.
• May coordinate other's activities.

Requirements:

• HS Diploma/GED
• 1+ years Professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
• 1+ years Experience in clerical or administrative role
• Basic MS/Office - Word, Excel and Outlook is required
• Must be able to type a minimum of 45 words per minute

Assets:

• Medicare and/or Medicaid is preferred
• Experience in a Hospital, physician or medical clinic is preferred
• Call center with high volume is preferred
• Medical Terminology/Coding (ICD -9 and CPT) is preferred
• Bachelors degree is preferred

Preferred Assets:

• Bi-lingual skills preferred -Prior medical/healthcare experience -Excellent communication and organizational skills

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:

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.