TRICARE Evening Authorization and Referral Coordinator - Phoenix, AZ

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.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). 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: Enter 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 Consistently meet established productivity, schedule adherence, and quality standards while maintaining good attendance

Required Qualifications:High School Diploma or GED1+ years of experience in a medical office or similar setting, in a medically related role such as customer service, administrative support, medical care or clericalWorking knowledge of Medical Terminology, ICD-9/10, CPT and HCPCS codesPrevious experience working with a computer and Microsoft Office products (ability to create, copy, edit, send & save using Word, Excel & Outlook)United States CitizenshipAbility to obtain favorable adjudication following submission of Department of Defense eQuip Form SF86Preferred Qualifications:TRICARE knowledge and experienceAssociate's Degree or some college

As a requirement of UnitedHealth
Group's contract with the Department of Defense, this position requires U.S.
citizenship and proof of favorable adjudication following submission of
Department of Defense eQuip Form SF86, (the National
Agency Check Legal and Credit or “NACLC”). Successful completion of the NACLC
process is a requirement for continued employment in this role. NACLC
processing will be initiated by our TRICARE Security Officer post-offer, and
can take 3-6 months for a final decision communication from the Department of
Defense. Candidates will be allowed to begin employment with UnitedHealth Group
in this role based on an interim clearance, and final results will be
communicated as they are received. Failure to obtain final NACLC approval will
result in termination from this role.

UnitedHealthcare
Military & Veterans is part of the family of companies that
make UnitedHealth Group one of the leaders across the US health care system.

We serve those who serve our nation, providing quality health care services to
millions of military beneficiaries across the (list region post award).

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 health care solutions.

It's not just business as usual. It is one of our proudest endeavors.

If you're ready to help make health care 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 UnitedHealth care 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.

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.