Energize your career with one of Healthcare’s fastest growing companies.
You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
This Business Operations Specialist position is required to handle increased workload associated with Prior Authorization system setup. The Prior Authorization system setup includes the loading of letters, updating of tables, loading clinical guidelines, and updating automated decision trees.
This role is vital since without it we will risk incomplete guidelines, incomplete or incorrect approval and denial letters loaded for each client for each migration resulting in increased cost to client and decreased member satisfaction.
Positions in this function include those responsible for providing process and operational support to the functions within Business Operations Specialist. Positions in this function may also be responsible for quality reporting, analysis and audits, and for developing plans and programs to support continuous quality improvement using applicable tools. *Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.
- Develop knowledge of department programs including regulatory / compliance guidelines, program specific workflow tools and processing requirements and rules
- Prioritize workload and work multiple program types in a given week. (Provider Query and Medicaid Chart Review)
- Develop and maintain effective professional relationships with providers to ensure strong program participation and quick response times
- Work between several data platforms simultaneously to create packages to send to provider offices
- Thoroughly review all content prior to sending requests
- Identify and escalate records that do not meet content standards
- Submit final packages through required data control / and release protocols
- Research and locate providers – finding those who have moved to new employer, closed a clinic or practice, or moved - and contact provider facilities to confirm contact and provider information
- Contact providers to explain program and request, set commitments for information return and explain options for completing and transmitting information
- Influence response of provider while ensuring legal, ethical, and regulatory guidelines are met related to advisement and influence of coding decisions made by providers
- Demonstrate effective communication skills
- Develop and manage on - going relationships with designated providers to reduce provider abrasion, drive program participation and enhance productivity and efficiency
- Anticipate and troubleshoot provider non - participation and create persuasive support for quick resolution of resistance
- Meet daily and weekly production standards
- Ensure provider communication meets legal and regulatory guideline regarding coding advisement and release of PHI
- Meet all standards for Quality
- Understand and apply rules for medical information handling across multiple programs and situations
- Extensive work experience, possibly in multiple functions
- Work does not usually require established procedures
- Work independently
- Mentor others
- Act as a resource for others
- Coordinate others' activities
- High School Diploma / GED (or higher)
- 5+ years of previous Hospital service, Provider service, or Customer Service experience
- 5+ year experience utilizing Microsoft Office applications (Intermediate to advance: Ability to create, edit, copy, send and save documents, and spreadsheets in Microsoft Word and Microsoft Excel)
There are several steps in our hiring process - it’s a thorough process because we want to ensure the best job and culture fit for you and for us. In today’s ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application/job questions). Once you submit your resume, you’ll receive an email with next steps. This may include a link for an on-line pre-screening test(s) (or what we call an assessment) that we ask you to complete as part of our selection process. You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail.