Clinical Administrative Coordinator - Phoenix, AZ - Full-time / Part-time

Position Description:

UnitedHealth
Group is working to create the Healthcare system of
tomorrow and you can help. Already Fortune 17, we are totally focused on
innovation and change.  We work a little
harder. We aim a little higher. We expect more from ourselves and each other.
And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're
building a high-performance Healthcare system that works better for more people
in more ways than ever. Now we're looking to reinforce our team with people who
are decisive, brilliant and built for speed. 
Join with us and start doing your life's best work.SM

Primary Responsibilities:

• Receives
  Care Coordination notification cases for non-clinical
  assessment/intervention and provides appropriate triage


• Processes
  out of network requests for consideration of in network level of benefits
  for physician specialty referrals for appropriate products


• Processes
  notification requirements for outpatient procedures, home health, DME,
  transition of care, and network gap issues


• Determines
  benefit coverage issues based on employer group contracts  


• Sets
  up/documents/triage cases for (CCR) Clinical Coverage Review


• Ensures
  all potential member needs are identified and forwarded to the appropriate
  Care Coordinator for risk validation when applicable


• Processes
  letters within DOI/DOL time frames


• Verifies
  appropriate ICD-9 and CPT coding usage


• Communicates
  to providers and members benefit determinations within DOI/DOL time frames
  


• Other
  duties as assigned by manager and/or director 

Required Qualifications:

• 1+
  year of Telephonic Customer Service experience.


• High School Diploma/GED.


• Ability
  to create, copy, edit, send & save using Word, Excel & Outlook.


• 6+
  months experience using Medical Terminology.

Preferred Qualifications:

• Medical Insurance or Medical Field experience.


• ICD-9
  and CPT coding knowledge.

Diversity creates a healthier atmosphere: 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.