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Clinical Administrative Coordinator - Tonawanda, NY
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Tonawanda, NY Tonawanda, New York |
About this job
Position Description:
Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives. As one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work. (sm)
What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
Primary Responsibilities:
- Serve as point of contact for providers or members regarding medical/behavioral/clinical services or benefits
- Extract and review fax requests for medical or clinical services
- Making outbound calls requesting medical/behavioral/clinical services or benefits information (e.g., from providers or members)
- Receive electronic referral form requests for medical/behavioral/clinical services
- Utilize phone system to respond to and transfer calls to appropriate individuals
- Ask callers standard questions to understand requests, gather necessary information, and assess urgency
- Access electronic member files using policy or id number
- Determine member eligibility
- Follow protocols to task requests appropriately
- Check procedure codes against notification requirements and benefit coverage to determine next steps
- Reference automated job aid tools via the computer to identify appropriate procedures when needed
- Access claims information
- Review and interpret call history documentation (e.g., case notes)
- Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)
- Take calls and questions from members and/or providers regarding case status
- Determine whether authorizations are required for requested medical services
- Reference automated job aid tools via computer to research relevant rules, regulations, or procedures
- Learn computer system and process changes and updates and incorporate into daily work
- Contact internal resources if necessary to clarify information
- Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests
- Provide/explain benefit information to members/providers
- Provide/explain authorization information to members/providers
- Communicate with clinical team to ensure provider receives a response when necessary
- Document call history information into relevant computer system
- Enter medical request data into relevant computer system
- Follow standard procedures to complete requests
- Request medical review via relevant computer system as needed
- Review and advise member/provider of status of a request (e.g., notification, authorization)
- Schedule appointments for members based on request
- Provide information regarding appointments and medical services to facilities staff to assist members
Requirements
Required Qualifications:
- High School Diploma/GED.
- 2+ years of professional experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties.
- 1+ year of professional experience in a Clerical or Administrator role.
- Healthcare Industry and/or Insurance Benefits experience.
Preferred Qualifications:
- Working knowledge of Medical Terminology/Coding (ICD-9 and CPT).
- Experience in a Call Center with high volume.
- Experience in a Hospital, Physician, or Medical Clinical environment.
- Working knowledge of Medicare and/or Medicaid.
- Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, & long periods of close vision looking at a computer monitor.
- Service Center environment with moderate noise level due to Representatives talking, computers, printers, & floor activity
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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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