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Utilization Review Coordinator - Albuquerque, NM - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Albuquerque, NM Albuquerque, New Mexico |
About this job
Position Description:
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM
As a member of our Utilization Review team, you will be supporting a clinical team that helps manage services for members receiving long term care benefits.
Primary Responsibilities:
- Respond to incoming provider faxes and calls
- Develop relationships within the provider community and health services team
- Resolve service inquiries which could include: Notification entry, Providers status of an existing notification and determining if notification is required, Complete notification wizard along with ICD-9 and CPT coding, and Research of provider concerns and issues
- Manage incoming calls from providers, managing requests for services from providers and Plan staff.
- Organize work and develop strategies to adapt to constantly changing workload as evidenced by: Performing multiple administrative tasks while concurrently triaging phone calls and incoming faxes and Timely response to provider and care coordination team needs
- Document within the clinical documentation system administrative actions, follow-up and key attributes necessary to track member setting of care and reportable indices.
- Responsible for the resolution of escalated calls that are received by the UR team.
- Document Member/Provider responses and call outcomes in CareOne as appropriate.
- Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.
Requirements
Required Qualifications:
- High School Diploma/GED
- 1+ year of professional experience working in an Office setting using the telephone and computer as the primary instruments to perform the job duties
- 1+ year of experience in a Clerical or Administrative support role
- Experience using a computer and Microsoft Office (Word, Excel, and Outlook)
Preferred Qualifications:
- Healthcare or Insurance Benefits experience
- Medical Terminology and ICD-9/CPT coding experience
- Knowledge of Medicaid and Medicare
- Experience working in a Hospital, Physician's Office, or Clinic environment
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.