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UnitedHealth Group Clinical Administrative Coordinator - Remote in Dallas, Texas

Energize your career with one of Healthcare’s fastest growing companies.

You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

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.

First point of contact for medical management activities. Receive inquiries regarding prior authorization, notification, peer to peer requests, and status requests. Determine requirements for authorization/notification and create a case in the applicable documentation system. Complete administrative approvals.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 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.

  • 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 triage

  • Processes out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate products

  • Processes notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issues

  • Determines benefit coverage issues based on employer group contracts

  • Sets up/documents/triages cases for (CCR) Clinical Coverage Review

  • Ensures all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicable

  • Processes letters within DOL time frames

  • Verifies appropriate ICD-10 and CPT coding usage

  • Communicates 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.

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

  • Proficiency in Microsoft Word (Creating and editing documents) and Microsoft Excel (Creating spreadsheets and working within spreadsheets)

  • Flexibility to work outside standard hours of operations due to changing business needs.

  • 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

  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Bachelor's Degree (or higher)

  • 2+ years of professional experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties OR 2+ years of Customer Service experience analyzing and solving customer problems

  • Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-9 and CPT codes, Medicare and/or Medicaid Services, call center environment

  • Professional experience in a Clerical or Administrative support related role

Soft Skills:

  • Ability to multi - task and to work in a fast-paced, dynamic, rapidly changing environment

  • Strong aptitude for working in a production driven environment

  • Must be a self-starter and able to work autonomously

  • Excellent oral and written communication skills

UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. You can learn more about all we are doing to fight COVID-19 and support impacted communities at: https://www.unitedhealthgroup.com/newsroom/addressing-covid.html

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. SM

Colorado Residents Only: The hourly range for Colorado residents is $15.00 to $25.19. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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: Clinical, Administrative Coordinator, UHG, Optum, Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #rpo

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