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Ability to read, interpret and comprehend insurance payment Remittance Advice/ Explanation of Benefits Review, appeal or request claim reprocessing to represent correct processing of insurance claims Contact insurance companies regarding claim processing and determining reason for payment delinquency or claim denial Contact various departments to help with corrections and submit appeals for outsta
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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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Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakehol
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Receives, reviews and coordinates all information required to initiate a referral for pre authorization for health care services for multiple practices. Follows protocols set up by New West Physicians and contracted payors. Utilized New West Physicians Practice Guidelines as required. Advises providers concerning the adequacy of the information contained in the referral. Makes suggestions within
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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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Distribute drugs prescribed by physicians and other health practitioners. Provide information to customers about medications and their use. Strong focus on providing a superior level of customer service. Log data into the computer. Ensure compliance with all relevant laws of the applicable State Board of Pharmacy. Administration of immunizations as allowed by state boards of pharmacy. Any other us
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Develops, supports, and maintains server system infrastructure Implementation and design of hardware & software End user support Performance reporting 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
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Develops, supports, and maintains server system infrastructure Implementation and design of hardware & software End user support Performance reporting 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
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Combine two of the fastest growing fields on the planet with 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 reliable. There's no room for error. Join
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Provide clinical education and manage marketing services to hospital and physician referral sources to ensure awareness ofOptum Specialty PharmacyInfusion Services programs and services Assess and coordinate, in partnership with Case Managers and Discharge Planners, home infusion services to assist with determining the plan of care administered byOptum Specialty PharmacyInfusion Services under t
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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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The Patient Experience Manager will support the team and function as a primary resource to ensure end to end service resolution and timely follow up. Patient Experience Department supports creating a complete and positive service experience from member enrollment, through all touch points within system and any escalated service recovery, if necessary. The PX Manager will provide support for the Co
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Perform research on various computer systems and document customer information regarding current status, payment expectations, notes of conversations and other relevant information Use mail, email and phones to contact customers to discuss, negotiate payment and resolve outstanding medical bill accounts and balances Obtain agreement on potential balance payoff and/or payment terms within stated le
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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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