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TRICARE Evening Authorization and Referral Coordinator - Colorado Springs, CO - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | Colorado Springs, CO Colorado Springs, Colorado |
About this job
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
Individuals in this position will be responsible for the daily processing of TRICARE referrals and authorizations for Military Health System (MHS) beneficiaries and coordination with the Military Treatment Facilities (MTF).
This position requires ACHA Level II Background
checks (fingerprinting) by the State of Florida for all Clinicians that have
face-to-face contact with members and will require renewal every five years.
Primary Responsibilities:
- Daily processing of referral and authorization service requests within TRICARE contract time standards.
- Makes benefit and coverage determinations based on TRICARE policy and UHCMV guidelines
- Processes MTF requests for identification and steerage for in network physician specialty referrals
- Sets up/documents/triages cases for Clinical Prior Authorization Review
- Verifies appropriate ICD-9,10 and CPT/HCPCS codes
- Resolve customer service inquiries which could include: entering referral/notifications, change provider status of an existing referral/notification and determining if referral/notification is required.
- Assist with faxes, emails, and letters to the beneficiaries, civilian providers and the MTFs
- Make outbound calls as needed to providers to gather required information for referrals and authorizations
- Attention to detail
- Consistently meet established productivity, schedule adherence, and quality standards while maintaining good attendance.
Requirements
- High School Diploma or GED
- Working knowledge of Medical Terminology, ICD-9/10, CPT and HCPCS codes
- 1+ year of experience in a Medical related role such as Customer Service, Administrative support, Medical office or Clerical related role.
- Previous experience working with a computer and Microsoft Office products (ability to create, copy, edit, send & save using Word, Excel & Outlook)
- United States Citizenship
- Ability to obtain favorable adjudication following submission of Department of Defense form SF86 . **
Preferred Qualifications:
- TRICARE knowledge and experience
- Associates Degree or some college
UnitedHealthcare
Military & Veterans is part of the family of companies that make
UnitedHealth Group one of the leaders across the US Healthcare system.
We serve those who serve our nation, providing quality Healthcare services to
millions of Military beneficiaries.
Our commitment to helping people live healthier lives, and to continue the
honor, satisfaction, and quality of the TRICARE Military Health Benefit program
is greater than ever. Our efforts complement the Military Health System to
demonstrate the best blend of public and private Healthcare solutions.
It's not just business as usual. It is one of our proudest endeavors.
If you're ready to help make Healthcare work better for those who serve our
nation. If you are smart, creative, and committed. If you want to make a
difference, consider being part of the elite team at UnitedHealthcare Military
& Veterans.
This is an opportunity to share in something special; a chance for all of us to
serve, to excel, and to know that we've made a difference for those families
who have made our nation stronger.
Careers at UnitedHealthcare
Military & Veterans. When it
comes to their healthcare, the men and women who help keep the peace deserve
the greatest peace of mind. That's why UnitedHealthcare is the organization
that's called on to serve them and their loved ones. We're all about finding
better ways to help improve their lives no matter where life may take them. So
our career opportunities take challenge to a higher level. If you have a
commitment to quality that mirrors our commitment to the men and women of the
armed forces, take time to learn more about the career paths available here.
It's a genuine opportunity to do your
life's best work.SM
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.
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