OrthoNet is a proud member of the UnitedHeath Group family of companies and a leading orthopedic specialty benefit management company. OrthoNet works with more than 80,000 orthopedic health care providers, including specialists in orthopedic surgery, neurosurgery, podiatry, and physical, occupational, and speech therapy. Our mission is to achieve optimal outcomes for payors, providers, and members in a manner that combines efficient delivery of services, high quality care, and state of the art utilization and cost management tools.
This is a hybrid role that will have two primary functions. As a Spanish Language Assistant this role will facilitate clinical communication related to utilization management documentation. This role will also provide support for Appeals and Denials activities.
- Comply with the National Council on Interpreting in Health Care (NCIHC) Code of Ethics and HIPAA regulations.
- In a timely manner and in accordance with required turnaround times, will provide written translation of Spanish documentation to member population.
- Translator will receive utilization management letters from the OrthoNet Denial and Appeals team on a daily basis with specific sections highlighted that need to be translated.
- Timeliness of translation is critical as translated documents are due back to designee in Denials & Appeals team in accordance with department requirements.
- The interpreter will process information quickly, concisely using appropriate terminology and understands common industry procedures and practices.
Appeals/Denials Coordinator Duties:
- Work with OrthoCare Managers to assure that information and compliance expectations are communicated to providers and/or members to meet the state regulations timeframe.
- Develop and maintain denial records to assure that all information is received, recorded and filed in the appropriate manner.
- Entering and maintaining information onto OrthoNet's various databases.
QUALIFICATIONS AND SKILLS:
- Associate Degree and/or minimum of 2 years of work experience in language interpretation or bilingual customer service, preferably in healthcare related environment.
- Completion of interpreter qualifying program [preferred]
- Proficient in translating health care-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
- Strong attention to detail and organizational skills.
- Professional and positive commitment to service delivery.
- Must be able to maintain professionalism and a positive attitude at all times.
- Ability to manage multiple tasks, projects and deadlines simultaneously.
- Excellent verbal and written communication skills.
- Strong ability in the MS Office Suite (MS Outlook, Word, Excel, and Power Point).