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Responsible for completing the process of credentialing providers employed by the Community Medical Associates (CMA) group for Boulder Community Health as required by each payer contract and government payer regulations Responsible for re credentialing providers via CAQH every 120 days to ensure provider credentialing statuses remain consistent. Coordinate with BCH Medical Staff Office to ensure a
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Enter prescriptions and verify appropriate and accurate information Contact patients, pharmacists and doctor's offices to resolve claims issues Process prescriptions (from intake to order completion) Resolve customer issues; ensuring accurate information is provided This role is equally challenging and rewarding. You'll need to work within multiple computer systems simultaneously as you respond t
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Work with UnitedHealthcare members visiting a pharmacy retail location, regarding medical and pharmacy benefits, eligibility & claims issues and assist with plan selection and enrollment. Identify opportunities to connect members to the best resources to meet their healthcare needs and help resolve medical and benefits issues on their behalf Interact with sales, pharmacy, and HouseCalls staff in a
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Review and process all incoming claim referrals. Ensure completeness and legibility of documents, coordinating with customer service, internal departments and/or facilities to obtain additional information as needed Communicate with staff and Account Coordinators (AC) to gather pertinent claim information as assigned Assign claims to data entry if the manual conversion process is not possible Cont
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Making outbound calls to care providers and minimal inbound calls Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems Contact care providers (hospitals) on behalf of the customer to assist with claims related issues or concerns Research complex issues across multiple databases and work with support resour
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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 restl
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Provide exceptional customer service to all customers while following best practices of call greeting, call handling, call documentation, call resolution and call closure. Provide 1st level technical support by creating and/or resolving ServiceNow Incident and Request cases. Troubleshoot problems with network connectivity, web access, Windows, Outlook access, Exchange, SQL connectivity, and propri
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Bring traditional actuarial skills to providers as the health care market continues to evolve, including Assisting in developing innovative strategies, policies and procedures Conducting and documenting moderately complex analysis and research Preparing, forecasting, and analyzing trends Initiating, compiling and preparing analytical models, tools and databases Providing detailed summaries, repor
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Delivery of documentation to Provider Meeting strict deadlines for any Provider notification. Assisting with scanning incoming mail Close claims within internal platform Document all communications and maintain up to date documentation on all claims in the Company's proprietary claims database system according to Company standards. Contribute to the development of innovative, practical solutions t
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Performs concurrent review of provider documentation, diagnoses and charge codes for Medicare Advantage members for assigned providers or sites to ensure proper ICD 10, CPT, CPTII, HCPCS and modifiers are applied. Query providers or clinic staff as necessary for clarification of documentation or lack thereof as it pertains to proper application of ICD 10 HCC diagnosis codes. Reviews additional c
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Planning System Center Configuration Manager hierarchy and site systems roles Creating and managing Boundary Groups across one or more Distribution Points Management of site communications. (Bandwidth, Secondary Sites, etc.) Role Based Administration Managing custom roles and security groups General monitoring of site health via SCCM console Planning, configuring and implementing a backup plan
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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 Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Joi
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Assist providers with examinations, minor surgical procedures and physicals May be required to perform certain tasks alone as instructed. These procedures may include but are not limited to Medical Duties Injections, sterile field set up, EKG, application of dressings and splints, PFT's, mass removal, flexible sigmoidoscopy, pap smears, pulse oximetry, orthostatic blood pressures, audiograms, spir
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Assist in answering incoming phone calls in a prompt and professional manner Return calls as appropriate Connect and disconnect answering service, and follow up on messages received from answering service Assist in taking phone messages in a concise and complete manner Ensure phone calls will not be left on hold for excessive periods of time Assist "unscheduled" emergencies to the point that medic
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Respond to and resolve customer service inquires and issues by identifying the topic and type of assistance the customer needs such as benefits, eligibility and claims, financial spending accounts and correspondence. Provide concierge and white glove level service, removing burdens and providing end to end resolution for customers Serve as a single point of contact for the customer and form a st
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