Saturday, September 21, 2013

Provider Rapid Resolution Expert - Houston, TX


Purpose of Job:

The purpose of this position is to delight our customers by resolving their issues through:

Fast and accurate problem identificationReal time and accurate resolution of simple adjustments and escalated claim issuesCall back within designated turnaround time with resolution or status of issues requiring additional research

Primary Responsibilities:

Quickly and accurately identify and assess provider issues and resolve the issues.Handle repeat callers, escalated issues and highly complex provider inquiries.Immediate identification of transfer for complex transaction issues to appropriate adjustment units.Ensure Customer Satisfaction through:

Maintain accurate documentation in system ORS.Provide callbacks to providers with status updates according to set timeframes.Responsible for any follow-up work needed for resolving and closing issues.Identify and resolve anticipated customer issues to prevent future calls.Thoroughly

research all open ORS inquiries based on established thresholds,

responsible for any follow-up work needed for resolving and closing

issues.Serve as first point of escalation for both internal and external business partners and other customers.

Provide excellent quality service to our providers and ensure that there is full understanding of the plan benefits.Quickly establish rapport relating to the customer in a polite, positive and courteous manner.Project patience, empathy, caring, and sincerity in voice tone and words.Express thoughts and information clearly and succinctly.Handle irate callers in a manner that defuses their emotion.Achieve quality and efficiency objectives.Maintain proficiency in all technical applications (technical skills and system knowledge)Comply with all current policies, procedures and workflows.Effectively communicate potential compliance or process issues to supervisor, as applicable.


Requirements:High school diploma or GED1+ years of experience in a Customer Service or Transaction environment requiredKnowledge of medical terminology and billing practices requiredProgressive knowledge of MS Office Applications (Word, Excel) requiredContract/Reimbursement policy experience requiredAbility to navigate the organization and network effectively to resolve issues across functional areasAbility to efficiently maneuver multiple systems to retrieve relevant informationAbility to work efficiently and effectively under time constraintsAssets:Medical claims background preferredWorking knowledge of claim adjustments preferredExperience with claims processing systems preferredKnowledge of State and Federal regulations which govern the Appeal process preferredWork Environment:Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouseOffice environment UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

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