Translate business rules and business requirements into system level requirements as part of user story refinement, documenting and communicating system changes Generates requirement documents that communicate process workflows and functional needs to both business stakeholders and technical staff. Maintains expertise and understanding of existing system functionality to

Serve as a resource or Subject Matter Expert (SME) for other team members or internal customers. Handle escalated calls, resolving more complex customer issues in a one and done manner. Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and expl

Monitor day to day operations of the SPARCS Intake System including incident reports, defect tracking and resolution, extract generation, and maintenance and release activities Serve as a key resource on complex and/or critical issues Solves complex problems and develops innovative solutions Perform complex data analysis primarily in SQL to support operations Collaborate

Assisting in the review of medical records to highlight Star / HEDIS opportunities for the medical staff. Review medical records for data collection, data entry, and quality monitoring including health plan / WellMed form submission and chart collection activities that close gaps in care. Partner with the leadership team, the practice administrative or clinical staff to i

Develops and executes strategies for a function or discipline that span a large business unit or multiple markets/sites Research and develop applicable business rules that support product reimbursement methodologies and policies for existing and new business opportunities (e.g., Medicare; Medicaid; commercial) Support ongoing maintenance of pay as state pay facility prici

Follow established departmental policies, procedures and objectives Notify Provider Enrollment Manager of non compliance issues May involve travel to meet with providers to ensure complete and accurate forms are completed Completion of PIN form for submission to Excellian, track payer data in Symed Follow up on outstanding enrollment issues to ensure timely reimbursement

Work on HIM configuration changes and builds by maintaining industry and client standards ensuring build quality and timeline adherence as well as debugging and resolving any issues/defects Translate user requirements into functional and technical design specifications and review with client(s) to ensure accuracy Serve as a mentor/subject matter expert to local and client

Help process provider 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 Work independently to resolve standard and non standard requests Consult with your supervisor on complex issues and problems Collaborate with others

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

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

Perform financial modeling, data analysis, and business unit support related to Revenue and Sales forecasting and performance Understand business drivers and metrics to assist in identification of revenue and sales trends and opportunities to improve performance Interface with business, finance, and growth leaders to build relationships in support of real time forecasting

Coordinate and supervise daily / weekly / monthly activities of a team members Set priorities for the team to ensure task completion and performance goals are met Coordinate work activities with other supervisors, managers, departments, etc. Identify and resolve operational problems using defined processes, expertise, and judgment Provide coaching, feedback, and annual pe

You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. 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

Full Time 40 weekly hours, M F, 8 5 pm 95% work from home, all equipment provided. Telecommute post training (3 6 months of onsite training at Oregon Medical Group) Assessing Red Flag calls escalated from nurse triage and determine appropriate level of care. Tech savvy, EPIC EMR Tele med acute care phone and video visits Opportunity for growth Compensation & Benefits High

Assess the training and organizational development needs within a function (e.g. claims) Participate in the development of training programs and classroom materials Provide leadership within the classroom or virtual classroom environment Report training metrics and generate training related reports Keeping pace with our instructional needs will be the biggest challenge fo