Senior Clinical Appeal Reviewer - Boise, ID

Company: UnitedHealth Group
Location: Garden City
Posted on: September 18, 2023

Job Description:

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 (9:00am - 5:30pm). It may be necessary, given the business need, to work occasional overtime. Our office is located at 322 E FRONT STREET, Suite 400 Boise, ID 83702 -
We offer 2-3 weeks of paid training. The hours during training will be 9:00am to 5:30pm, Monday - Friday. - Training will be conducted in the office.
Primary Responsibilities:

Act as a Subject Matter Expert for other team members
Manage the intake of members or the admission/discharge information post notification.
Work with hospitals, clinics, facilities, and the clinical team to manage requests for services.
Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification, and census roles.
Resolve inquiries from members and/or providers.

Part of the challenge here is dealing positively with members and providers in sometimes challenging circumstances. As a subject matter expert, you'll also be the "go-to" resource for information. The flexibility to work evening hours will also be required.
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)
1+ years customer service experience
1+ years experience analyzing and solving customer problems
1+ years of healthcare/ insurance experience and/or social work/community outreach/advocacy experience
1+ years of professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties.
Work experience using Microsoft Word (edit, create & save documents), Microsoft Excel (sorting & filtering data), and Microsoft Outlook (email, folders, attachments, and calendaring)
Ability to work any of our 8-hour shift schedules during our normal business hours of (9:00am - 5:30pm). It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

Bachelor's degree (or higher) in social work, Public Health, or related field
Medicaid and / or Medicare experience
Experience working with medical terminology

Soft Skills:

Excellent Organizational Skills
Must be comfortable making outreach to members without prior engagement.
Must be able and comfortable with maintaining metrics and goals within the department.
Must be comfortable working multiple systems on the computer simultaneously while assisting members.

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.
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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

Keywords: UnitedHealth Group, Boise , Senior Clinical Appeal Reviewer - Boise, ID, Healthcare , Garden City, Idaho