Specialty Navigator I

UnitedHealth Group • Norwood, MA

1d • $16 - $29 • Hybrid

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, the Specialty Navigator I process referrals and authorizations for Atrius Health patients. Receives inbound requests (calls, emails, faxes, etc.) as well as from within the work queues. Maintains patient records and continually provides information to patients and specialists.
Schedule: FT, 40 hours. Monday – Friday, 8:30am – 5pm.
This is a hybrid role – hybrid schedule to be determined by manager upon hire.
Location: 1177 BOSTON PROVIDENCE HWY NORWOOD, MA 02062
If you live near NORWOOD, MA, you will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges.

Requirements

• High School Diploma/GED (or higher)
• 1+ years of customer service experience, preferably in a healthcare setting
• Intermediate level of proficiency with creating, editing, saving and sending documents utilizing Microsoft Word and Excel
• Intermediate level of proficiency with typing and talking at the same time and navigating through multiple screens

Nice To Haves

• Experience working within the healthcare industry and with healthcare insurance
• Experience working in a metric-driven work environment
• Call center experience
• A clerical or administrative support background
• Knowledge of ICD-9 and CPT codes
• Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seek assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager
• Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations
• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Responsibilities

• Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles
• Handle resolution/inquiries from members and/or providers.
• This is high volume, customer service environment. You'll need to be efficient, productive and thoroughly dealing with our members over the phone
• Answers and replies to a large volume of telephone calls, faxes and internet queries, utilizing and adhering to department scripts and guidelines
• Reviews patient record. If referral does not already exist, obtain authorization from payer, enter information into EPIC. Forwards authorization to specialist’s office
• Keeps patient and facility informed of status, referrals, updates and process
• Obtains authorization from payer websites efficiently and effectively. Keeps log in and credentials
• Research questions and concerns from patients; assists in resolving any issues as they relate to the referral process
• Escalates difficult issues, problems, etc., to higher level coordinators or supervisory staff
• Works with team to ensure timely process of referrals. Participates in team problem solving activities, focusing on production and quality
• Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations
• Written Communications: Ability to summarize and communicate in English moderately complex information in varies written formats to internal and external customers
• Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers
• Teamwork: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members
• Accesses only the minimum necessary protected health information (PHI) for the performance of job duties. Actively protects the confidentiality and privacy of all protected health information they access in all its forms (written, verbal and electronic, etc.) taking reasonable precautions to prohibit unauthorized access. Comply with all Atrius Health and departmental privacy policies, procedures and protocols. Follows HIPAA privacy guidelines without deviation when handling protected health information
• Performs other duties as assigned

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED