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Clinical Administrative Coordinator - US Telecommute

02/08/2018Call Center
Job Location:
Phoenix, AZ
Metro Area:
AZ - Phoenix
Company Name: UnitedHealth Group
Website:  Click to Visit
UnitedHealth Group
Position Description:There may be easier administrative jobs out there, but few offer the satisfaction of truly helping people manage their personal health and well-being. UnitedHealthcare, part of the UnitedHealth Group family of businesses, is serving employers and individuals, states and communities, military families and veterans wherever 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. Our customer service teams have a serious responsibility to make every contact informative, productive, positive and memorable. If you're the kind of person who wants to bring your contribution to a new level every day, find out more.Primary Responsibilities:Respond to Incoming Provider and Enrollee calls.Resolve Customer Service inquiriesProvide 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 emails.Moderate work experience within own function.Some work is completed without established procedures.Basic tasks are completed without review by others.Supervision/guidance is required for higher-level tasks.Other duties as assigned by manager and/or director


Required Qualifications:High School Diploma / GED or higher1+ years of professional experience in an office / customer service environment.Previous Healthcare Industry experienceKnowledge of Medical TerminologyPrevious experience working with Microsoft Word, Outlook and Excel (ability to create, edit, send and save documents).Computer proficiency including, but not limited to, ability to learn new computer system applications.Flexibility to work outside standard hours of operations due to changing business needs.Must have a quiet secure designated work space and access to install secure high speed internet (minimum speed 1.5 download mps and 1 upload mps) via cable / DSL in home (NOTE: wireless / cell phone provider, satellite, etc...does NOT meet this requirement)Preferred Qualifications:Bachelor's Degree or higherExperience working within a Hospital, Physician's Office, or Medical Clinical setting, ICD-10 and CPT codes, Medicare and/or Medicaid Services, call center environment.Professional experience in a Clerical or Administrative support related role.Bilingual in 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.Keywords: UHG, Clinical, Healthcare, Administrator, UnitedHealthcare, Medical Terminology
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