Clinical Administrative Coordinator - US Telecommute - Full-time / Part-time

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.Our Customer Service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care. Employees in this position include those responsible for initial Triage of members, Administrative Intake of members or managing the Admission/discharge information post-notification, and working with hospitals and the Clinical team. Function includes managing Incoming calls, managing requests for services from Providers/members, providing information on available Network services and transferring members as appropriate to Clinical staff. Also manages the Referrals process, processes Incoming and Outgoing Referrals, and Prior Authorizations. This function also includes Intake, Notification and Census roles.Primary Responsibilities:Respond to Incoming Provider and Enrollee callsResolve Customer Service inquiries Provide excellent Customer Service to both Providers and Enrollees.Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.Receives Care Coordination notification cases for non-clinical assessment/intervention and provides appropriate triageProcesses out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate productsProcesses notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issuesDetermines benefit coverage issues based on employer group contractsSets up/documents/triages cases for (CCR) Clinical Coverage ReviewEnsures all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicableProcesses letters within DOL time framesVerifies appropriate ICD-10 and CPT coding usageCommunicates to providers and members benefit determinations within DOL time framesAssist with faxes and emailsModerate work experience within own functionSome work is completed without established proceduresBasic tasks are completed without review by othersSupervision/guidance is required for higher-level tasksOther duties as assigned by manager and/or director

Required Qualifications:High School Diploma or GED1+ years of professional experience in an office/customer service environmentPrevious experience working with Microsoft Word, Excel, and OutlookComputer experience including, but not limited to, ability to learn new computer system applicationsFlexibility to work outside standard hours of operations due to changing business needsPreferred Qualifications:Bachelor's Degree or higherProfessional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties, or Customer Service experience analyzing and solving customer's problemsExperience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and/or Medicaid Services, Call Center environmentProfessional experience in a Clerical or Administrative support related roleExperience with Lotus NotesBilingual fluency in English and SpanishCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.