Job Description

Complex Customer Care Representative

ProHealth Physicians (CT), part of the Optum family of businesses, is seeking a Complex Customer Care Representative to join our team in Farmington, CT. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while 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 8:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime. Employees are required to work some days onsite and some days from home.

We offer 4-8 weeks of paid training. The hours during training will be 8:00 am to 4:30 pm EST, Monday - Friday. Training will be conducted onsite and virtual.

Primary Responsibilities:

• Documents all member interactions in a concise manner that is compliant with documentation requirements for Model of Care, NCQA and Center for Medicare and Medicaid Services (CMS) regulations.
• Receives and responds to incoming Care Coordination inquiries from all communication venues: e.g., phone queue, CM/UM electronic platform, portal, department e-mail box or RightFax.
• Coordinates and assists in monitoring of documentation Care Management queues for Disease Management, Transitions of Care, Complex Care, and Social Work referrals.
• CTA processes CM requests via all communication venues; as well as administrative preparation for clinical staff.
• Conducts in-bound and out-bound calls for program requirements including, but not limited to: member scheduling, surveys/screenings, census management and distribution of materials to appropriate clinical personnel or members.
• Performs daily preparation of INPT and Post-Acute Census for use in CM referrals, and informs Care Management Manager of outstanding cases to ensure adherence to NCQA regulations.
• Completes timely data entry of in-bound and/or out-bound call member contact information into software applications.
• Provides clerical and/or administrative support to clinical staff and managers for special projects and reporting needs.
• Provides excellent customer service by serving as a resource to all internal and external customers.
• Attends required meetings and participated in ad hoc committees as needed.
• Maintains knowledge of all health plan benefits, network, NCQA regulations, health plan policies.
• Identifies opportunities for process improvement in all aspects of member care.
• Must always maintain strict confidentiality.
• Must adhere to all department/organizational policies and procedures.
• Performs all other related duties as assigned

Required Qualifications:

• High School Diploma / GED OR equivalent years of work experience
• Must be 18 years OR older
• Certified Medical Assistant Training
• 2+ years of administrative support experience working in a medical care setting as a medical assistant (within the last year)
• Medical terminology knowledge base
• Advanced knowledge of Microsoft Office products, including Excel, Word, and Outlook
• Ability to toggle between multiple IT systems and platforms
• Ability to work full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 4:30 pm EST.

Preferred Qualifications:

• Active Medical Assistant Certification
• 2+ years of experience in a physician's clinic or hospital
• Ability to prioritize, plan, and handle multiple tasks/demands simultaneously
• Ability to work independently, with some supervision and direction from manager
• Ability to maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times
• Ability to possess and demonstrate excellent organizational skills, customer service skills, to include verbal and written communication

Telecommuting Requirements:

• Reside within commutable distance to the office at 3 FARM GLEN Blvd Farmington, CT.
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving
• Able to prioritize, plan, and handle multiple tasks/demands simultaneously

Physical and Work Environment:

• Ability to lift up to 25 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.98 - $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

UnitedHealth Group

Job Tags

Minimum wage, Full time, Work experience placement, Live in, Work at office, Local area, Remote work, Monday to Friday, Shift work

Similar Jobs