Senior Patient Care Coordinator - Redwood City, CA (107445711)
Healthcare isn’t just changing. It’s growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that’s what fueled these exciting new opportunities.
Who are we? Optum360. We’re a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we’ll leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.
If you’re looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.SM
Positions in this function are responsible for checking in, scheduling appointments, answering billing questions and managing patient medical records for a clinic. Roles may vary based on the size of the clinic(s).
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.
- Know, understand, incorporate, and demonstrate the Optum360 and client Mission, Vision, and Values in behaviors, practices, and decisions
- 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
- Accommodate payer requests for clinical reviews and Medical Record and facilitate verbal discussion between the respective facility, physician groups and the payer, as required
- 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
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.
- High School Diploma / GED (or higher)
- 2+ years in Acute Care Facility or Centralized Business Office performing one of various functions including (but not limited to):Self - Pay Collections , Pre - Registration / Financial Clearance , Patient Check-In and Registration, Financial Counseling , OR other functions related to revenue cycle activities in a complex, multi - site environment
- Proficient in Microsoft Office including Word, Excel, and Outlook (ability to create, copy, edit, send, and save documents, spreadsheets and emails)
- Knowledge of Medical Terminology
- Maintain current knowledge of process and systems, and regulatory issues and requirements
- 2+ years of substantial experience in a Revenue Cycle role
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
- Experience working with MS4, Mede/Analytics, Cerner, and/or Citrix
- Proficient in Google Workspace
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military
Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet
Careers with Optum360. At Optum360, we're on the forefront of health care innovation. With health care costs and compliance pressures increasing every day, our employees are committed to making the financial side more efficient, transferable and sustainable for everyone. We're part of the Optum and UnitedHealth Group family of companies, making us part of a global effort to improve lives through better health care. In other words, it's a great time to be part of the Optum360 team. Take a closer look now and discover why a career here could be the start to doing your life's best work.SM
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.
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