Clinical Administrative Coordinator

UnitedHealth Group•Tampa, FL

13h•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

Requirements

High School Diploma / GED OR equivalent work experience
Must be 18 years of age OR older
1+ years of experience in front office, back office, coordinator, insurance OR medical group
Ability to work an 8-hour shift during our normal business hours of 8:00am - 5:00pm PST, including the flexibility to work occasional overtime and weekends (rotate weekends every other weekend), based on the business need

Nice To Haves

2+ years of office experience in healthcare industry at the corporate level
1+ years of experience in insurance eligibility
Intermediate level of experience with Microsoft Suite

Responsibilities

Consistently exhibits behavior and communication skills that demonstrate our company's commitment to superior customer service, including quality, care and concern with each and every internal and external customer
Performs effective prospective and concurrent review of requested services according to established guidelines and timeframes
Documents members’ service benefits by contacting the appropriate health plans as needed
Directs providers/members to contracted provider network and facilities
Processes appropriate authorizations for HMO/PPO clients as specified in the Optum procedures
Enters, updates and closes referrals daily while assuring that appropriate internal/external referral providers are utilized, members are eligible and have benefits coverage, correct CPT/ICD-9 codes have been entered, accurate records of all dates and other required fields are entered, supporting clinical data for the referrals is entered, and all urgent referrals are processed within the designated timeframe
Processes referrals for durable medical equipment and coordinates home health services according to established policies, procedures and guidelines
Coordinates, identifies and routes referrals that require review to licensed Care Management staff who arranges outside physician medical review as appropriate
Acts as a resource to other coordinators, staff and providers by resolving issues and responding to requests in a timely and effective manner
Works with Patient Services regarding member concerns
Processes referrals for inter-facility transfers using pre-established guidelines
Processes after-hours emergency/urgent care logs/lists as needed
Collects and prepares medical records for review when appropriate or as requested
Assists with answering telephones and maintaining files, logs or other reports
Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Assist with Insurance and benefits verification
Attends and participates in Interdisciplinary rounds