Patient Care Coordinator - Worcester, MA

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

Location: 5 Neponset St., WORCESTER, MA

Work hours: Monday through Friday, 8 hour shift between the hours of 6:30 AM and 6:30 PM

Primary Responsibilities:

• Respond to patient questions in person or over the phone
• Greet patients and build rapport to provide a positive patient experience
• Collect patient payments
• Make patient follow up calls (e.g., after procedures, admissions, or ER visits) to identify/close gaps in care
• Ask patients for and/or assist patients with completing required paperwork (e.g., health history, insurance documentation, etc.)
• Connect patients with outside resources (e.g., community resources, social services) to promote self care
• Review and support implementation of patient plan of care
• Work directly with patients to identify specific needs and/or request adjustments to plan of care
• Coordinate services/case management for non-episodic and non-catastrophic cases
• Manage/respond constructively to challenging patient interactions (e.g., address lack of understanding, socioeconomic challenges frustrated patients, language barriers)
• Explain and talk to patients or caregivers about sensitive health care decisions such as advanced directives, physician's order for life sustaining treatment, and palliative care/hospice referrals
• Explain and ensure understanding of details related to patient care (e.g., , home health care transition procedures)
• Explain medical benefits/coverage specifics (e.g., procedures/amounts covered, denials of coverage, appeal rights)
• Utilize Computer Systems to Pull/Verify/Enter Patient Data
• Access insurance plan systems to verify insurance eligibility/benefits for patients and seek additional information as necessary
• Input/update patient demographic data into computer system
• Update/upload patient care data (e.g., care plan data, inpatient data, patient program flags) in computer systems
• Document patient interactions in appropriate systems/logs (e.g., medication changes)
• Enter/process patient referral data (e.g., medical services, radiology, durable medical equipment)
• Generate reports on patient data through relevant computer systems/applications
• Review/analyze patient data reports (e.g., discharges, hospital admissions/readmissions, skilled nursing facilities) and follow up as necessary
• Identify inconsistencies in diagnosis/procedure codes and update codes in the system
• Enter patient payments, prepare deposits, and balance daily deposit log/ledger
• Draft/provide written communications to patients (e.g., standard letters, welcome letters, educational materials) in compliance with company and health plan guidelines
• Maintains patient/staff data and generates aggregate data report

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 (or higher) 
• 1 + year of experience working in medical front office position and/or customer service experience

Preferred Qualifications:

• Understanding of relevant health plan guidelines and benefits (e.g., Medicare, Medicaid/Medical, commercial benefit plans, Federal/local government regulations)
• Understanding of Federal privacy regulations (e.g., HIPAA)
• Knowledge of safety guidelines/practices (e.g., OSHA)
• Knowledge of basic medical terminology and human anatomy to document patient information using standard language/medical terminology
• Understanding of evidence-based practice guidelines (e.g., Millliman) to evaluate medical necessity of procedures
• Understanding of managed care policies/procedures that apply to patient care
• Understanding of managed care practices/contract provisions to evaluate appropriateness of services (e.g., contracted providers, financial implications, relevant regulations  

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. 

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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