Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each internal and external customer Perform all functions of the UM nurse reviewer Composes denial letter in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA sta

Deliver high quality patient care through face to face, telephone, and electronic contact for examination, treatment, monitoring, and preparation for diagnostic tests or procedures Collect and document patient information, including vital signs, chief complaint, review of medications, allergies, health risk screen information, the status of extended care benefits, and oth

Oversee processing of physician adds, terms and demographic changes Review and verify provider panel status and current health plan IDs Manage and maintain current roster of primary care and specialty care physicians Support patient retention workflows during provider network changes Distribute materials, performance/patient data, and communications to physician network S

Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer. Serves as a primary point of contact between patient and health care team to anticipate and appropriately address patient questions and concerns. Confirms patient u

Deliver high quality patient care through face to face, telephone, and electronic contact for examination, treatment, monitoring, and preparation for diagnostic tests or procedures Collect and document patient information, including vital signs, chief complaint, review of medications, allergies, health risk screen information, the status of extended care benefits, and oth

Life Changing Work Want to make a real difference in the lives you touch? LOOK NO FURTHER. Optum provides management services to multiple long respected physician groups in Southern California. We are passionate about patients. We are leading the state of California toward better healthcare practices. And we are looking for amazing doctors like you. As part of our continu

Coordinate, supervise and accountable for the daily / weekly / monthly activities of a team of 15 to 20 Medical Collections Representatives Set priorities for the team to ensure task completion and performance goals for the team are achieved Coordinate work activities of team with other supervisors, managers, and departments Participate in the recruitment, training, and s

Manages ongoing contract relationships and service delivery to clients for up to 30 accounts Acts as outward facing, dedicated resource for assigned accounts, typically with direct client contact (not call center) and large or complex accounts Builds relationships with Provider leadership and serves as the primary point of contact for overall and day to day service delive

Greets patients as they arrive and manage appropriate standard wait times Complete check in and check out tasks to include patient demographic verification, insurance verification, complete pre authorizations and/or precertification of procedures, and copy required documents Collects co payments, co insurance, and deductibles and issues receipts Manages cashier box and da

Manage the evaluation of payer proposals related to Fee For Service (FFS), capitation arrangements and value based contracts Partner with the payer contracting team to manage the modeling and negotiation process, evaluate proposals, and provide guidance to senior leadership on the financial impact and viability of the contract Work closely with the Finance and Actuarial t

Provides facility level oversight for processes and initiatives designed to improve Revenue Cycle performance in the areas of Registration, including Point of Service Collections Financial Clearance Financial Counseling, including collaboration with Self Pay Eligibility staff Customer Service Other duties as assigned by the local client, including but not limited to Patie

Supervises clinical operations of a given patient care area Assists Site Administrator in ensuring compliance with licensing, certification, and competencies Evaluates nursing competencies and decisions according to current nursing practices Functions as a resource and serves as a liaison between administration, clinicians, staff, and other departments Participates in all

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Position in this function is responsible for all activities associated with Utilization Management (UM) programs. Ensures all UM activities a

Operational/Procedural Responsibilities Serves as an internal resource to clinical departments around charge capture and charge master updates Works with the revenue producing departments to ensure the ongoing coordinated consistency of the Chargemaster, including accurate descriptions, coding, additions, deletions, pricing and any other changes Monitors revenue complianc

Family Medicine Physician Los Angeles, CA 2225680 NOTICE OF FILING OF APPLICATION FOR PERMANENT EMPLOYMENT CERTIFICATION This Notice is being provided as a result of the filing of an application for permanent alien labor certification for the position shown below. Any person may provide documentary evidence bearing on the application to the Certifying Officer, U.S. Depart