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Work cooperatively and collaboratively as a member of a care team with primary care providers, medical assistants, care coordinators, and other clinic staff to provide care to patients based on best practices and evidenced based medicine Serve patients across the lifespan from newborn to geriatric Provide nursing assessment and comprehensive health management to patients under longitudinal and epi
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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 propriet
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Coordinate work for, and work with, Claim Representatives, Appeal Analysts, triaging medical records, setting up claim appeals in Optum Systems, and other duties to be determined. Set up Appeals (includes receive, analyze, evaluate, and track appeal documents; follow inquiries and complaints through final resolution) by established processes and procedures, and within established time standards. P
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Conduct quality reviews of all eligible Equian external documents, to include Forensic Reports, Appeal Responses and calculations, Reports delivery to clients and providers Complete miscellaneous production related tasks as required for support including scan records, process triage forms and process referrals. Perform research to support quality review findings, exceptions and resolve issues Perf
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Handle mail and invoices, distribute and file as required. Answer telephones and direct calls. Order office supplies Prepare shipments and mailings. Communicate with customers by phone and in person Data entry Process and file paperwork Check inventory Various other related duties as assigned Educational or Skills Requirements High school diploma or equivalent. Ability to use automated systems and
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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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Responsible for establishing and maintaining positive relationships and actively marketing to referral sources within the hospital, physician offices, or healthcare facilities. Information resource for home health service/SNF services Resources for early intervention Assist complex patient conferencing as needed. Daily rounds on hospital floors and morning meetings with all case managers to colla
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Under limited supervision, applies the appropriate diagnostic and procedural codes to individual patient health information for data retrieval and analysis and claims processing Abstracting pertinent information from patient records Assigning ICD 10 CM / PCS or HCPCS codes, creating APC or DRG Group assignments Queries physicians when code assignments are not straightforward or documentation in th
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Assessment of business capability requests to determine current and future infrastructure needs Work with end users to improve business and system capabilities Work with and coordinate appropriate IS staff to implement solutions which will meet or exceed customer expectations Communicate complex infrastructure concepts at multiple levels across the business partner landscape effectively driving co
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Manage unit cost budgets, target setting, performance reporting and associated financial models Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controls Ensure that net
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Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management Develop and execute strategies for a function or discipline that span a large business unit or multiple markets / sites Apply network configuration and incentive based payment models as appropriate to improve quality and efficiency Direct others t
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Consult and partner with executive leaders to develop and execute internal communication plans that reinforce the business plans, strategies, mission and values of Optum and Optum Care Mountain West. Collaborate with applicable stakeholders to help define their communications needs and preferences (e.g., business objectives or issues to be addressed, desired outcomes, root cause analysis) Write an
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Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Educate customers about the fundamentals and benefits of consumer driven health care, guiding them on topics such as selecting the best benefit plan options, maximizin
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Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members Execute applicable provider incentive programs for health plan Assist in the review of medical records to highlight Star opportunities for the medical staff Activities include data collection, data entry, qual
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Serve as a resource or Subject Matter Expert (SME) for other team members or internal customers Handle escalated calls, resolving more complex customer issues in a one and done manner Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
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