Clinical Administrative Coordinator

Employer: UnitedHealth Group

This opportunity is with one of our most exciting business areas: Optum a growing part of our family of companies that make UnitedHealth Group a Fortune 10 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

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.

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.

This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our 8-hour shift schedules during Tuesday – Saturday, Sunday – Thursday, or Monday – Friday between 8:00 am – 6:00 pm. It may be necessary, given the business need, to work occasional overtime.

We offer 8 weeks of paid training. The hours during training will be 8:00am to 4:30pm Monday-Friday. Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Respond to Incoming Provider and Enrollee calls
• Resolve Customer Service inquiries
• Provide excellent Customer Service to both Providers and Enrollees
• Meet established productivity, schedule adherence, and quality standards while maintaining good attendance
• Receive Care Coordination notification cases for non – clinical assessment / intervention and provides appropriate triage
• Process out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate products
• Process notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issues
• Determine benefit coverage issues based on employer group contracts
• Set up / document / triage cases for (CCR) Clinical Coverage Review
• Ensure all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicable
• Process letters within DOL time frames
• Verify appropriate ICD – 10 and CPT coding usage
• Communicate to providers and members benefit determinations within DOL time frames
• Assist 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

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED (or higher)
• 1+ years of professional experience in an office / customer service environment
• Healthcare experience
• Computer experience including, but not limited to, ability to learn new computer system applications
• Experience working with Microsoft Outlook (email and calendar management), Microsoft Word (create and edit correspondence), and Microsoft Excel (ability to create, edit, save and send emails, documents and spreadsheets)
• Ability to work Tuesday – Saturday, Sunday – Thursday, or Monday – Friday between 8:00 am – 6:00 pm (40hrs per week). Flexibility to work outside standard hours of operations due to changing business needs

Preferred Qualifications:

• Bachelor’s Degree (or higher)
• Bilingual fluency in English and Spanish
• Professional experience in a Clerical or Administrative support related role
• Experience working within a Hospital, Physician’s Office, or Medical Clinical setting, Medical Terminology, ICD – 10 and CPT codes, Medicare and / or Medicaid Services, Call Center environment
• Professional 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 problems

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service (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)

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