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UM Phone Representative

Company: UnitedHealth Group
Location: Redlands
Posted on: January 20, 2023

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) -The Utilization Management Phone Representative works under minimum supervision to perform routine and complex clerical tasks; answers referral status and determination questions from patients, family members, health plans, and other clinic personnel. Also intakes verbal requests for organization determinations from patients or an appointed representative, and enters those requests into the Utilization Management referral system for processing. Ensures good internal and external public relations including coordination of communication between functional units within Utilization Management to improve customer service outcomes. -Primary Responsibilities: -

  • Receives and processes incoming telephone calls into the department, and maintains a log of incoming calls by reason for the call. -
  • Assists patients with questions regarding their referrals and determinations through application of a thorough knowledge and timely access to referral management systems. -
  • Performs auditing functions of patient referrals including verifications of insurances and eligibility. -
  • Acquires and files additional clinical documentation pertaining to incoming calls and inquiries to support referral management and organization determination functions. -
  • Assists patients with the appeals process with the health plans. -
  • Processes and inputs new verbal referral requests from patients or an appointed representative, and enters the request into the referral management system. -
  • Make outbound calls to members and providers regarding organization determinations to meet regulatory notification turnaround time requirements. -
  • Researches returned mail searching for current addresses, correcting patient information as necessary, and filing signed certification slips in referral system. -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 (preferred) or equivalent experience
    • 1+ year of experience in a medical environment, office or clinicPreferred Qualifications: -
      • 2+ years of managed care experience in medical office/clinic
      • Bilingual -To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) - -For more information on our Internal Job Posting Policy,--- -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: UnitedHealth Group, Redlands , UM Phone Representative, Other , Redlands, California

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