Customer Service Quality/Audit Representative Senior – National Remote in Dallas, Texas

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

ProHealth Physicians is a physician-led medical group with 85 practice locations throughout Connecticut serving more than 10% of the state’s residents. We empower physicians and advanced clinicians to better serve patients through enhanced care processes in support of improved patient outcomes. Formed in 1997, ProHealth Physicians has grown to include more than 350 primary care and specialty clinicians and offers select specialty and diagnostic/therapeutic services.

The Customer Service Quality/Audit Representative Senior (CSQ Audit Rep) supports the Optum Care East Region Quality and Audit team through data collection, report creation, and case audits. This position will also serve as a liaison for new hire staff to ensure successful onboarding and access to required platforms and applications.

This position is full-time, Monday – Friday. Employees are required to have flexibility to work during our normal business hours of 8:00am – 4:30pm EST. It may be necessary, given the business need, to work occasional overtime.

We offer 2-3 weeks of paid training. The hours during training will be 8:00am – 4:30pm EST, Monday – Friday.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Management of phones, fax, and team email.

• Directing communications to the correct department/individual.

• Managing calls from members and providers.

• Providing case data to health plans for appeals or overturns.

• Completing non-clinical case and call audits.

• Daily report generation for Affordability and Quality metrics.

• Obtaining clinical documentation from EMR.

• Ordering staff equipment.

• Completing secure requests for system access.

• Providing onboarding services and orientation for new staff with supervision.

• Gathering system data for focused audits.

• Troubleshooting with IT for staff access issues.

• Collaboration with development of non-clinical process documents.

• Review and completion of regulatory reports.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED OR equivalent work experience.

• Must be 18 years of age OR older.

• 2+ years of administrative support experience.

• Knowledge of Microsoft Office products including Excel, Word, and Outlook.

• Ability to toggle between multiple IT systems and platforms.

• Ability to prioritize, plan, and manage multiple tasks/demands simultaneously.

• Excellent organization skills and customer service skills to include verbal and written communication.

• Demonstrate a high degree of professionalism to always include personal conduct and appearance.

• Ability to work during our normal business hours of 8:00am – 4:30pm EST.

Preferred Qualifications:

• 2+ years of experience in a medical clinical or hospital environment.

• Certified Medical Assistant training or certification.

• Experience with peer review or quality auditing.

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable).

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $19.47 – $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment .

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