Position Description:Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.UnitedHealth Group is working to create the health care system of tomorrow.Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant and built for speed.The Field Retention Representative meets members face to face and solves issues regarding medical, pharmacy, or dental benefits, eligibility and claims, prior authorization / notification requests, while delivering compassionate service and resolving issues. This role takes ownership in the end to end escalation situation, collaborating with business partners to ensure that issues are resolved timely and communicated clearly to the provider.Primary Responsibilities:Ensures quality customer service for internal and external customersResponds to incoming customer service requests verbally in person and with written correspondenceIdentifies and assesses customers' needs quickly and accuratelySolves problems systematically, using sound business judgmentPartners with other billing and eligibility department representatives to resolve complex customer service inquiriesMonitors delegated customer service issues to ensure timely and accurate resolutionApplies appropriate communication techniques when responding to customers, particularly in stressful situationsInforms and educates new customers regarding billing / invoicing set up and billing / payment proceduresResponds to customer service inquiries in writing as necessaryProcesses member terminations (i.e. phone disenrollment)Establishes and demonstrates competency in eligibility, billing and receivable systems and associated applicationsImplements customer service strategies and recommends related improvements / enhancementsMaintains timely, accurate documentation for all appropriate transactions.Makes corrections and adjustmentsConsistently meets established productivity, schedule adherence, and quality standardsProactively seeks to further develop billing and accounts receivable competenciesKeeps management abreast of all outstanding issuesAdapts procedures, processes, and techniques to meet the more complex position requirementsSeeks involvement in continuous quality improvement initiativesEnsures quality customer service for internal and external customers
Required Qualifications:High School Diploma / GED (or higher)2+ years of customer service experience2+ years of provider service experience Intermediate skills with Microsoft Excel (ability to create spreadsheets, filter content and perform V-lookups), Microsoft Word (ability to create, edit, and save advanced documents), and Microsoft Outlook (ability to send emails)Must have reliable transportationKnowledge of State and Federal Regulations of CMS and Florida MedicaidAbility to work Monday through Friday flexible 8 hour shift with ability to work weekends as necessaryPreferred Qualifications:Bachelor's Degree (or higher)Prior experience as a resolution specialist, claims rep or prior authorization agentExperience dealing with dual special needs plansBilingual fluency in SpanishKnowledge of medical claims billing ICD9, CPT, or HCPC CodesSoft Skills:Excellent communication, time / project management, problem solving, organizational, and analytical skills Physical Requirements and Work Environment:Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computerService center environment with moderate noise level due to Representatives talking, computers, printers, and floor activityCarrying laptop equipment, moving popup banners, and carrying promotional itemsCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.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.Keywords: customer service, Medicaid, Medicare, Florida, benefits, claims, coding, prior authorization
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.