Remote Outbound Call Center Agent

ECS Clinical Coverage Review / Prior Auth

Purpose of Job:

Positions in this function are responsible to determine if prior authorization is required and can be decisioned, or if it requires additional clinical review. Individuals support clinicians by contacting health providers and/or members to verify authorization or referral, setup cases, and document findings. Positions in this function includes those responsible for initial triage of members, administrative intake of members and working with hospitals and the clinical team.

Primary Responsibilities:
This is a production role and you will have the responsibility to meet production, quality and regulatory expectations
Ensure case is set up correctly and document required information
Review, research and determine if case can be decisioned or if it requires additional clinical review
Demonstrate proficiency and decision making by solving complex problems using available resources (documents, medical policy, standard operating procedure, etc.)
As needed, make outbound calls to providers and/or members to obtain information regarding a case
As needed, make outbound calls to providers to coordinate provider availability in treating members
Other duties as assigned by manager and/or director
Qualifications

Required:

Minimum of a High School Diploma / GED
1+ years of professional experience in an office or healthcare environment
Prior customer service experience making outbound calls
Proficiency in using a computer
Experience working with Microsoft Office Products including Microsoft Outlook (ability to create, edit, save, and send emails), Microsoft Word (ability to create, edit, save, and send documents), and Microsoft Excel (ability to create, edit, save, and send spreadsheets)
Ability to work an eight (8) hour shift Monday-Friday between 7am-7pm; Tuesday-Saturday or Sunday-Thursday shifts may be available
Flexibility to work outside standard hours of operations due to changing business needs
Ability to trouble shoot and setup computer equipment independently
Must have a designated work area established that is separate from other living areas and can be secured to maintain PHI or PI security in line with UnitedHealth Group policies and standards
Remote but MUST live in a location that can receive a dedicated hard-wired high-speed internet connection or leverage an existing high-speed internet service provider (ISP) (minimum speed 1.5 download mps and 1 upload mps). In areas where a UnitedHealth Group approved ISP is not available, manager approval to leverage a local ISP and receive reimbursement for business utilization is required and available on exception basis only
Preferred:

Previous experience working with back office medical platforms and/or authorizations systems
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and/or Medicaid Services
Professional experience in a Clerical or Administrative support related role
Able to quickly learn various computer systems or applications
Soft Skills:

Strong communication skills; Written and verbal
Excellent critical thinking and problem - solving skills
Candidate needs to be highly organized
Analytical, problem solving and decision-making skills; ability to exercise good judgment