Per Diem Insurance Verification Specialist

Explore opportunities with Optum, in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together.

The Insurance Verification Specialist provides detailed and timely communication to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. They ensure preauthorization and referral requirements are met prior to the delivery of system services that require authorization.

The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. Training will be conducted virtually from your home.

Our office is located at 2085 North Calhoun Road Brookfield, WI 53005.

If you are located within commutable distance of the office, you may opt to work onsite, otherwise, you may enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Demonstrate strong knowledge of insurance requirements including processing of all referrals requiring authorization based on plan & type of referral
• Initiate contact w/ payers to complete insurance verification activities to prevent delays in care due to missing authorizations
• Use critical thinking to troubleshoot & contact payers and patients as necessary to secure coverage & authorizations prior to services being rendered
• Navigate EMR, insurance portals/protocols associated with each payer for authorization activities, including identifying & providing all relevant clinical information to support the authorization
• Document all authorization related information using medical terminology appropriate to the service in the EMR to support continuity of care. Includes information gathered during the verification or authorization process
• Update health record w/ accurate information regarding insurance coverage based on information gathered during verification &/or authorization process
• Obtain required authorizations, pre-certifications and 2nd opinion surgical approval for inpatient/out-patient procedures for multiple service lines, depts & modalities across the continuum. Identify/escalate barriers to obtaining authorization to the insurance company or per dept protocol
• Respond to insurance company inquiries for information. Includes consent forms, pre-authorization forms, 2nd opinion forms & referral forms
• Coordinates w/ providers, payers, depts, & patients regarding authorization status and options & documents outcomes in the EMR
• Confirms payment coverage including the initiation of insurance & managed care authorizations
• Communicates w/ providers & clinical delegates to resolve any outstanding information regarding pre-authorization & referral requirements
• Perform electronic eligibility confirmation as needed; verify insurance for encounters & visits as assigned
• Completes assigned tasks in EMR work queues & brings work lists to completion
• Generates forms to insurance companies: consent, pre-authorization, second opinion and referral. Provides outcome of requested surgery/procedure order referrals to requesting MD/nurse & patient when applicable
• Notify provider of denied procedure/request for peer-to-peer discussion with insurance company & adjust authorization status accordingly
• Works independently & as part of a team in conjunction with Utilization Review/other depts as necessary to provide appropriate clinical information from the EMR to appeal the denials from the insurance company to secure financial payments
• Follow-up on discharge status of patients & relay information to insurance carriers as they require
• Actively participates in identifying/implementing improvements of department/organizational processes to more efficiently & effectively meet business objectives & educate staff as appropriate
• Accountabilities include completion of compliance requirements, achievement of productivity standards, & maintenance of competency levels/quality standards as defined by the organization

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

• 1+ years of experience in medical billing, medical insurance verification, managed care and/or patient registration

• 1+ years of experience with health insurance plans including Medicare, Medicaid and commercial carriers

• 1+ years of experience working with an EMR system

• 1+ years of experience working with pharmacy/medication prior authorizations

• Intermediate level of proficiency with Microsoft Office products

• Must be 18 years of age or older

Preferred Qualifications:

• 1+ years of experience in an acute care billing/insurance verification/managed care/registration department

• Previous experience with prior authorizations and referrals

• Previous experience with Epic medical record and medical terminology

• Epic experience

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)

• Must 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:

• Consistent professional behavior and ability to handle confidential information

• Demonstrates initiative and is a self-starter

• Must demonstrate well-developed communication skills - oral and written

• Excellent customer service and relational skills

• Able to work independently, prioritizing and organizing workload effectively to complete tasks within the timeframes delegated

• Must be flexible to handle workflow demands

*All Telecommuters 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 $16.15 to $28.80 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before 

#RED, #GREEN