Note: The job is a remote job and is open to candidates in USA. UnitedHealth Group is a health care and well-being company dedicated to improving health outcomes globally. The Clinical Administrative Coordinator will manage administrative intake of members, process referrals and authorizations, and assist clinical staff while handling member inquiries.
Responsibilities
- Managing administrative intake of members
- Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers
- Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
- Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
- Handle resolution/inquiries from members and/or providers
- Extract and review of fax requests for medical or clinical services, and ensure that these requests are assigned to the correct individual(s)
- Access electronic member files using policy or id number
- Determine member eligibility
- Provide support to field staff in locating providers who can assist our members. This will include calling/ emailing / faxing multiple providers
- Mail member materials, including care plans, and open, sort and distribute incoming correspondence via hard copy or e-mail
- Fax care plans to providers on the members' care team
- Follow protocols to task requests appropriately
- Reference automated job aid tools via the computer to identify appropriate procedures when needed
- Consistently meet established productivity, schedule adherence, and quality standards while maintaining good attendance
- Maintain Confidentiality and adhere to HIPAA Requirements
- Heavy calls
- Performs other duties as assigned
Skills
- High School Diploma / GED
- 2+ years of customer service experience working within the healthcare industry and with healthcare insurance
- Intermediate level of experience in working with Microsoft Office, including Microsoft Word (ability to create, edit, save, and send documents), Microsoft Excel (ability to create, edit, save, and send spreadsheets), Microsoft PowerPoint (ability to open, edit, save, and send documents), and Microsoft Outlook (ability to create, edit, save, and send documents)
- Intermediate level of experience working with computer and Windows personal computer applications, which includes the ability to learn new and complex computer system applications
- Ability to work shift (40 hours / week) between the hours of 8:30 AM - 5:00 PM (Eastern Standard Time zone) from Monday - Friday including the flexibility to work occasional overtime based on business need
- Reside within the state of New Jersey
- Experience with working in a hospital, physician's office, OR medical clinic setting
- Experience working in a call center
- Clerical or administrative support background
- Knowledge of ICD - 9 and CPT codes
Benefits
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
Company Overview