Precertification Representative - Remote in Eastern Time zone

About the position

The Precertification Representative at Optum Eastern is a vital role within the Optum Care Delivery team, focused on managing administrative tasks related to service requests from members and providers. This position supports the clinical team by processing referrals and prior authorizations, ensuring efficient communication and resolution of inquiries. The role emphasizes collaboration, diversity, and inclusion, contributing to the overall mission of improving healthcare for all.

Responsibilities

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  Manage administrative intake of members
  
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  Work with hospitals, clinics, facilities, and the clinical team to manage requests for services from members and/or providers
  
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  Process incoming and outgoing referrals, and prior authorizations, including intake, notification, and census roles
  
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  Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
  
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  Handle resolution/inquiries from members and/or providers
  

Requirements

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  High school diploma / GED OR equivalent work experience
  
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  Must be 18 years or older
  
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  2+ years of customer service experience
  
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  Experience with Microsoft Word, Microsoft Excel, and Microsoft Outlook
  
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  Ability to work any of our 8-hour shift schedules during our normal business hours of 8:30am - 5:00pm, with occasional overtime as needed
  

Nice-to-haves

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  Experience working within the health care industry and with health care insurance
  
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  Experience working in a hospital, physician's office, or medical clinic setting
  
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  A clerical or administrative support background
  
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  Knowledge of ICD-9 and CPT codes
  
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  Experience working in a call center
  

Benefits

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  Comprehensive benefits package
  
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  Incentive and recognition programs
  
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  Equity stock purchase
  
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  401k contribution
  

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