[Hiring] Clinical Administrative Coordinator @UnitedHealth Group

Role Description

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.

The Optum Care Clinical Administrative Coordinator team is responsible for the initial triage of clinical claim reviews, administrative preparation of cases for nurse review and working with others in claims operations and clinical teams. The initial triage includes using departmental resources to validate the appropriateness of the case for the Medical Claim Review nurses. The Clinical Administrative Coordinator is responsible for verifying claim information, member eligibility, related utilization management and prior authorization information in the claims payment system. This role includes managing clinical letters as directed by the nurses.

This position is full-time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 4:30 pm. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of paid training. The hours of training schedule might adjust based on training availability.

Primary Responsibilities:

• Access claims information in the claims payment system
• Determine if Medical Claim Review is required for the service(s) using department resources (e.g., job aids, prior-authorization lists, MCR Code List)
• Verify member eligibility
• Determine health plan and network
• Verify prior authorization and/or inpatient utilization review information in claims payment system
• Create and send letters to providers as directed by nurses
• Follow standard procedures to complete work, including departmental job aids and policies
• Learn computer system and process changes and updates to incorporate into daily work
• Navigate between computer screens and platforms to research information (e.g., medical, clinical or benefits information)
• Applies knowledge/skills to activities that often vary from day to day
• Works with others as part of a team
• Prioritize and organize work to meet deadlines
• Work with supervisor to solve more complex problems
• Other duties assigned by leadership

Qualifications

• High School Diploma/GED or equivalent work experience
• Must be 18 years of age or older
• Ability to type 45 Words Per Minute
• Computer literacy, Microsoft Office Suite (Microsoft Word & Microsoft Outlook)
• 1+ years of medical claims review OR claims processing experience
• Ability to work full-time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am – 4:30 pm. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications

• 2+ years administrative experience in healthcare setting

Telecommuting Requirements

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

Soft Skills

• Demonstrated attention to detail

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.