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: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 / GED or higher 1+ years of professional experience in an office / customer service environmentPrevious experience working with Microsoft Office including Outlook (ability to create, edit, save, and send documents), Word (ability to create, edit, save, and send documents), and Excel (ability to create, edit, save, and send documents)Computer experience including, but not limited to, ability to learn new computer system applicationsFlexibility to work outside standard hours of operations due to changing business needsMust have a quiet 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, microwave, etc...does NOT meet this requirement)Preferred 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.SMDiversity 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, Administrative, UnitedHealthcare, Telecommute
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.