Primary Care Delivery Deliver cost effective, quality care to assigned members Manage both medical and behavioral, chronic and acute conditions effectively, and in collaboration with a physician or specialty provider Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Me

Provide expertise and support by reviewing, researching, investigating and auditing problematic claims Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance Responsible for all aspects of quality assurance Extensive work experience with multitasking in multiple functioning processes To work within the es

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. Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California

Prepares the patient for the Medical Provider's examination by obtaining vital signs and patient history Prepares and maintains the examination and treatment areas Prepares the patient for and assisting with the examination, procedures or treatments. Maintains medication and medical history up to date Performs sterilization techniques Performs an inventory of supplies and

Collaborate with development and support teams to plan future iterations Monitor existing deployments for any bottlenecks to fine tune the system Ensure all aspects of product development follow compliance and security best practices and policies Remediate any security findings found in existing security tools Deploy and maintain applications in the cloud using services l

Greets visitors and patients in person, or communicates by telephone or video conferencing, upholding excellent customer service Enters and updates patient demographic and financial information, ensuring the patient is fully registered as early in the process as possible Obtains appropriate applications and forms, confirming signatures are on file, Photocopies / scans doc

Communicates directly with patients and / or families either in person or on the phone to complete the registration process by collecting patient demographics, health information, and verifying insurance eligibility / benefits Utilizes computer systems to enter access or verify patient data in real time ensuring accuracy and completeness of information Gathers necessary c

Conduct MS DRG and APR DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification Expert knowledge of and the ability to identify the ICD 10 CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD 10 Official

Specially trained in customer service and initial chart creation to ensure accuracy and a positive financial impact. This includes but is not limited to validating patient demographics, guarantor and subscriber demographics, insurance, PCP, email, social security, and other relevant information within the computerized system to ensure it is complete, accurate, and insuran

Collects and records initial client information to include type of referral, type of insurance, and patient demographics Requests the referral source fax orders on all patients. Verifies client benefits Notifies pharmacy, nursing, RT, and HME when verification complete Coordinates with HME to insure availability of requested supplies or equipment Obtains authorization for

Review comprehensive diagnostic evaluations to ensure valid diagnosis has been given Obtain clinical information from providers on Applied Behavior Analysis requests for treatment Determine if additional clinical treatment sessions for Applied Behavior Analysis are medically necessary in accordance with appropriate level of care guidelines Manage outpatient cases througho

By serving as the link between patients and the appropriate health care personnel, the SICC is responsible for ensuring efficient, smooth, and prompt transitions of care Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays Review targets for Length o

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, c

Enter all compounds are prepared in accordance with USP and USP guidelines Ensure all calculations on compounding worksheets are accurate and correct, record compounding procedures, lot and expiration dates of ingredients/supplied used Responsible for inspection, cleaning, operating, and maintenance of all compounding equipment, instruments, and work surfaces necessary/re

Consistently exhibits behavior and communication skills that demonstrate our company's commitment to superior customer service, including quality, care and concern with each internal and external customer Assist with projects geared to improve efficiency and cost savings Assists in preparing custom denial letters as requested by Care Management team Prepares member notifi