Specialty Navigator

UnitedHealth Group•Worcester, MA

37d•$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, the Specialty Navigator reviews complex referral requests and evaluates and assigns appropriate specialists 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 Reliant and Atrius Health and with external partners. Department: OB/GYN Schedule (38.75 hours/week): Monday – Friday 8:30am – 5pm EST or 8:00am – 4:30pm EST If you reside within the state of Massachusetts, you will enjoy the flexibility to telecommute as you take on some tough challenges.

Requirements

High School Diploma/GED (or higher)
1+ years of receptionist, admin support, or healthcare-related experience
Intermediate level of proficiency with MS Office tools
Must reside in Massachusetts
Ability to work independently and maintain good judgment and accountability
Ability to prioritize tasks to meet all deadlines
Ability to work well under pressure in a fast-paced environment
Demonstrated ability to work well with health care providers
Strong organizational and time management skills
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Nice To Haves

1+ years of experience working in a medical front office position performing duties such as scheduling appointments, checking patients in/out, insurance verification, collecting co-pays and maintaining medical records
Proficiency in Microsoft Office (Word, Excel and Outlook)
Knowledge of Epic EMR software
Ability to learn new software (EPIC/EMR) and flexibility to attend new hire training
Previous call center experience

Responsibilities

Reviews referral information from clinicians for pertinent information regarding tests, consultations and procedures
Verifies demographics and insurance information
Work is highly complex and 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 for 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
Redirect 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
Explain denials to patients. Keeps patient informed of status of all referrals (approved and denied)
Notifies patients of scheduled appointments and confirms appointments by mail including confirmed location and map of destination
Inform patients of any preparation that must be completed prior to the appointment
Contact patient if insurance coverage issues arise during the referral process so that patient can work directly with the insurance company
Promotes the Reliant and 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
Research 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 acquire 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, contact 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)
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
Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance
Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents
Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager
Written Communications: Ability to summarize and communicate in English moderately complex information in varied 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
Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations
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
Complies with health and safety requirements and with regulatory agencies
Complies with established departmental policies, procedures, and objectives
Enhances professional growth and development through educational programs, seminars, etc.
Attends a variety of meetings, conferences, and seminars as required or directed
Regular, reliable and predictable attendance is required
Performs other similar and related duties as required or directed

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.)

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