Support efforts to create new analytical insights and capabilities related to operational effectiveness, quality, outcomes, performance, and other related areas Partner with analytics insight team and principals to create solutions that effectively support all known requirements and effectively answer the relevant questions about performance and opportunities for optimiza

Provides care in the individual and group setting Works with primary care providers throughout the organization to provide education and monitoring services for all referred patients Works closely with the staff and providers to identify patients that require education and monitoring services Manages a caseload of patients independently Assesses patients for their learnin

Lead efforts to create new analytical insights and capabilities related to operational effectiveness, quality, outcomes, performance, and other related areas Partner with analytics principals to create solutions that effectively support all known requirements and effectively answer the relevant questions about performance and opportunities for optimization Support priorit

Work closely with data analysts to transform specification into client algorithms (4 Oracle, 2 Snowflake) Code complex procedures to support new client algorithms (4 Oracle, 2 Snowflake) Contribute to technical documentation of specifications and processes Responsible for weekly data loads and balancing of 9 accounts (6 Oracle, 3 Snowflake) Investigate data anomalies to d

Pricing support for OptumInsight Payer software and services product suite Pull and manipulate operational and financial data Maintain and enhance pricing models and templates Effectively work with cross functional teams that include Finance, Sales, Product and Operations Develop a strong understanding of the business mission through effective interactions with upper mana

Primarily answering prior authorization with inbound calls (up to 50 to 70 calls per day) from members as well as research and resolve formulary and benefit issues using the appropriate reference material Process member prior authorization requests through various computer systems and use of job aid/policies/procedures ensuring the accuracy of all data and updating as nec

for our Front Office Assistants include Assist in opening and closing the clinic, locking and unlocking the doors, and maintaining a clean waiting area Welcome all clinic patients and visitors by greeting them with a friendly demeanor, answering inquiries and directing them through the registration process Answer multi phone lines, complete daily patient callbacks, and fi

Blood collection from adult and pediatric patients using vacutainer, syringe and butterfly techniques; capillary puncture using heel and fingerstick techniques Identifies and labels specimens appropriately Instructs patients in regard to urine and stool collection procedures Enters accessioning data into the computer Prepares specimens for send out testing Inventories sup

Proactive pipeline development assist in development of sales opportunities. Analyzing current pipeline and support the development of an EAP sales forecast. Monitor what activities work well and what don't, with the goal of continuously optimizing existing approaches Sales tools creating and managing effective sales tools including customer focused, engaging content that

Creates a great consumer and clinic partner experience and continually builds strong relationships with both groups to proactively meet their needs. Serve as an expert to the clinical staff and proactively meets with their team on meeting their clinical outcomes. Counsels and educates patients on the usage of medications, adverse effects, schedules and any personal questi

Creates a great consumer and clinic partner experience and continually builds strong relationships with both groups to proactively meet their needs Serves as an expert to the clinical staff and proactively meets with their team on meeting their clinical outcomes Counsels and educates patients on the usage of medications, adverse effects, schedules and any personal questio

Creates a great consumer and clinic partner experience and continually builds strong relationships with both groups to proactively meet their needs Serve as an expert to the clinical staff and proactively meets with their team on meeting their clinical outcomes Counsels and educates patients on the usage of medications, adverse effects, schedules and any personal question

Review, process and identify medical claims based on standard operating procedures on CPS. Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates). Review and apply member benefit plans and provider contracts, Pricing,

Direct provider compliance and payment integrity audit reviews based on applicable standards, state/federal regulations, customer requests, internal requests, or project assignments Centrally manage full spectrum of audit operations, from audit strategic planning to coordinating recovery of financial penalties Direct audit program development in a fast paced, cross functi

Remain up to date with the contract requirements Use clinical judgement to ensure a clear, comprehensive and concise exam documentation that is reflective of the patient's service level conditions and in compliance to contract requirements Interpret and document diagnostic test results Educate and support provider with navigating and utilizing medical history information