Referral Navigator Representative - Utilization Management - Kelsey Seybold - Remote

UnitedHealth Group•Pearland, TX

15d•$16 - $28•Remote

About The Position

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. The Referral Navigator Representative provides administrative support for the referral navigator department. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. 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.

Requirements

High School diploma or GED from an accredited program
2+ years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting
Experience in creating authorization requests or billing Medicare or private insurance companies
Knowledge of medical terminology, coding, COB payment, and prior authorization processes

Nice To Haves

Graduate from accredited medical assistant program
Experience with precertification and/or utilization management
Knowledge of CPT & ICD 10 Coding methodologies and billing
Knowledge of insurance payer specific prior authorizations requirements
Solid knowledge of HMO, PPO, and POS plan types including Medicare and commercial health plans
Benefit interpretation

Responsibilities

This position is primarily responsible for coordinating with KS clinical staff to assist with the entry of prior authorization requests for utilization review
This includes interpretation and communication of covered benefits and exclusions, prior handling and appropriately directing prior authorization status requests received from KSC staff and assisting with requesting clinical updates
Other duties as assigned