VetJobs - The Leading Military Job Board

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:00am - 6:00pm PST). It may be necessary, given the business need, to work occasional overtime. Our office is located at Sequoia Hospital 170 Alameda de las Pulgas, Redwood City, CA 94062.

Primary Responsibilities:

• Know, understand, incorporate, and demonstrate the Optum360 and client Mission, Vision, and Values in behaviors, practices, and decisions

• Accommodate payer requests for clinical reviews and Medical Record and facilitate verbal discussion between the respective facility, physician groups and the payer, as required

• Demonstrate excellent customer service skills by facilitating communication between the hospital facilities, physician groups and payers

• Demonstrate effective assessment skills relative to providing adequate documentation and / or response as requested and / or required by the payers

• Maintain awareness of payer assigned time frames and understand specific payer UM details

• Collaborate and alert facility Case Managers of: Out-of-Network payers, additional payer needs, and Physician Advisor review

• Provide timely payer notification of all in-patient admissions to ensure timely authorization of inpatient days followed by timely and accurate documentation

• Provide communication and / or documentation, as required, in order to ensure concurrent authorizations for Labor & Delivery patients exceeding the 48/96 rule

• Facilitate the scanning, copying, and mailing of documents for deferred cases or for cases involved in a concurrent clinical appeal

• Perform tasks within ADT (“Admit Discharge Transfer”) system to ensure documentation of TAR and commercial clinical denials

• Educate and inform patient(s) of insurance benefits and eligibility

• Create good faith estimates and collect patient liability to ensure KPI (Key Performance Indicator) goals are met

• Monitor payer and State portals and websites for documents related to commercial certification, Treatment Authorization Request (TARs), and Service Authorization Request (SARs)

• Maintain a working knowledge of applicable Federal, State, and local laws and regulations, Optum360's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior

• Work is frequently completed with established procedures and work independently, may act as a resource for others or may coordinate others' activities

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• 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.)

• More information can be downloaded at: http://uhg.hr/uhgbenefits

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 Qualifications:

• High School Diploma / GED (or higher)

• 2+ years in Acute Care Facility or Centralized Business Medical Office experience performing one of various functions including (but not limited to):Self - Pay Collections , Pre - Registration / Financial Clearance , Financial Counseling , OR other functions related to revenue cycle activities in a complex, multi - site environment

• 2+ years of substantial experience in a Revenue Cycle role

• Advanced level of proficiency of Health Care Insurance Plan/Payers

• Basic level of proficiency of Medical Terminology

• Ability to work onsite at Sequoia Hospital 170 Alameda de las Pulgas, Redwood City, CA

• Ability to work full-time, Monday - Friday between 7:00am – 6:00pm PST including the flexibility to work occasional overtime given the business need

Preferred Qualifications:

• Proficiency in Google Workspace

California Residents Only: The hourly range for California residents is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #RED