Help process provider credentialing and enrollment applications and re applications including initial mailing, review and loading into the database tracking system Conduct audits and provide feedback to reduce errors and improve processes and performance Demonstrate great depth of knowledge/skills in own function and act as a technical resource to others Solve complex pro

As a part of OptumCare, Reliant Medical Group is seeking an APC to join our APC Collaborative Teaching Pod within our Internal Medicine Department in Southborough, Massachusetts . Qualified candidates will be a new graduate or have one year experience or less, working in primary care. At the time of application, candidates must submit a letter of intent, outlining their i

First point of contact for our patients. Sets the tone for a positive experience Exhibits empathy, courtesy, competence, efficiency and care Schedules appointments and procedures, following standard guidelines Uses Multiple computer and phone systems to fulfill patient needs over phone Verifies patient information, while documenting in their Electronic Health Record (EPIC

Gathering business requirements for the data warehouse as well as business intelligence reports used by the Virginia DMAS management Analyzing existing design and recommending industry best practice design for optimal performance and maintenance Applying Full Software Development Life Cycle (SDLC) experience, including Analysis, Design and Review of Business and Software

Obtain accurate and updated patient information, such as name, address, insurance information Perform insurance verification on the date of service Obtain patient signatures for required documents File and maintain medical records Confirms and schedule appointments Follow the Cash Security policy and procedures according to Optum Medical guidelines Perform referral docume

This is a part time position approximately 24 hours weekly; 3 days a week Load vehicles with medications/products for delivery Provide timely and accurate completion of deliveries in an efficient and courteous manner Verify receipt and provide signature for receipt of items delivered Process any required paperwork according to established procedures Shred paperwork for di

Ensures excellent customer service when assisting patients, providers, and other departments over the phone or in person Collects and verifies patient demographic and insurance information, making changes as necessary to ensure accuracy within each encounter Engages other departments to assist with patient questions or needs Facilitates conversations with patients to prov

Evaluates customer interactions in accordance with monitoring program guidelines. Conducts audits, identify trends, and provides feedback to reduce errors and improve processes and performance. Participates in weekly calibration sessions to ensure inter rater reliability. Presents quality program to new hire training classes. You'll be rewarded and recognized for your per

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

Interview patients in a hospital setting and work effectively with hospital personnel to assist patients with obtaining maximum benefit coverage Complete applications for state and federal programs Review medical records and take all necessary actions to expedite benefit approval Adhere to company and legal standards regarding Protected Health Information (PHI), Personal

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

Care Coordination Assist the provider/team with various care coordination activities in the nursing home and/or assisted living community (AL) RN works in collaboration with the nursing facilities/AL community to assist in coordinating transportation when appropriate Benefit Determination Assist the provider/team with benefit determination associated with Medicare part A,

Distribute drugs prescribed by physicians and other health practitioners Provide information to customers about medications and their use Solid focus on providing a superior level of customer service Log data into the computer Ensure compliance with all relevant laws of the applicable State Board of Pharmacy Administration of immunizations as allowed by state boards of ph

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

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