Specialty Navigator I
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.
Requirements
- High School Diploma/GED
- 1+ years of customer service experience, preferably in a healthcare setting
- Intermediate level 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
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
- 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 authorizations from payer websites efficiently and effectively. Keeps log in and credentials
- Researches 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
- 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. Complies 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
- 8 Paid Holidays
- Medical Plan options
- participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance
- 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.)
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
