Specialty Navigator II

UnitedHealth Group • Norwood, MA

13h • $18 - $32 • Remote

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, reviews complex referral requests and evaluates and assigns appropriate specialist for the patient. Works with patients and providers to understand services being requested. Interviews patients as needed to obtain full understanding of what information is being requested. Works closely with Specialty Nurses to ensure clinical handoffs are safe and appropriate. Coordinates care both within Atrius Health and with external partners.
Schedule: Monday – Friday, 8:30am – 5pm
Location: This role is fully remote.
You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Requirements

• High School Diploma/GED (or higher)
• 2+ years of scheduling experience in a medical office setting
• Beginner level proficiency with MS Word, Excel and Outlook

Nice To Haves

• Experience working within the health care industry and with health care insurance
• Experience working in a hospital, physician's office or medical clinic setting
• Previous experience with procedure scheduling
• Previous experience with EPIC
• A clerical or administrative support background
• Knowledge of ICD-9 and CPT codes
• Experience working in a call center

Responsibilities

• Reviews referral information from clinicians for pertinent information regarding tests, consultations, and procedures. Verifies demographics and insurance information. Work is highly complex detail oriented, involving frequent contact with a range of internal and external contacts as well as the need to understand terms and processes of multiple payers
• Reviews referral information from work queue for pertinent information regarding referral requests
• Reviews each external referral for opportunity to convert to internal referral and reviews options with patients. Redirects patients with managed care products appropriately ensuring clinical handoff is safe using expertise of specialty nurses. Ensures adequate information is obtained and relayed when care is moved
• Explains insurance benefits and options to patients. Explains denials to patients. Keeps patient informed of status of all referrals (approved and denied). Notified patients of scheduled appointments and confirms appointment by mail including confirmed location and map of destination. Informs patient of any preparation that must be completed prior to the appointment. Contacts patient if insurance coverage issues arise during the referral process so that patient can work directly with the insurance company
• Promotes the Atrius Health System of Care by highlighting internal providers and their expertise
• As needed, places orders to start the referral process for the PCP on behalf of patients who have booked appointments and call for the referral. Researches the visit notes to determine if a referral was intended as well as processing referrals for follow-up or annual visits that require a referral
• Schedules patients for tests, consultations, services and procedures with other departments, local private offices, and/or outside vendors/providers
• Answers phone calls, faxed requests and other inquiries relating to referrals and communicates with the physicians and clinicians to acquiree authorization or to inform them of patient issues or clinical paperwork needed
• Research questions/concerns from patients regarding bills and determines if issue is related to the referral process. Assists in resolving billing and denied referral matters as they relate to the referral process. Refers patients to appropriate staff (e.g., patient account representatives) for billing issues related to insurance benefits and services covered under the benefits plan
• Works in collaboration with the person designated as the Practice’s Benefits coordinator to maintain cost control, ensure that services provided are within benefit plan guidelines, and that necessary policies and procedures are followed when dealing with non-preferred providers/vendors. May coordinate second opinion requests
• Works with supervisors to ensure patients are receiving timely responses and detailed answers to their complex questions
• Research questions/concerns from patients regarding billing and determines if issue is related to the referral process. Assists in resolving billing and denied referral matters as they relate to the referral process
• Receives escalated issues and stat same day calls; determine appropriate action and/or works with clinical team for decision
• Effectively deescalates issues with upset patients and practices. Uses advanced listening techniques to understand the issue and give patients options as they are available. Escalates to supervisors only as needed
• Supports roles within the Navigator. Trains and teaches as needed
• Participates in problem solving activities, focusing on productivity and quality. Works with supervisors to ensure continuous improvement of the department
• If needed, contacts appropriate parties to obtain referral authorizations and verify coverage (e.g., the Authorization Services Unit (ASU), National Imaging Associates (NIA) or individual insurance companies). Certain departments may also need to contact additional outside agencies for approval (e.g., American Imaging Management or Med Solutions)
• Performs other duties as assigned
• 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

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