Clinical Admin Coordinator - Remote

Description

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

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 Clinical 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.

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

Primary Responsibilities:

• Access claims information in the claims payment system
• Determine if Clinical Claim Review is required for the service(s) using department resources (e.g., job aids, prior-authorization lists, CCR 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
  

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
• 2+ years of administrative experience in healthcare setting
• Solid computer literacy, Microsoft Office Suite
• Ability to type 45 words per minute
• Have a location/workspace in the home separate from non-workspace areas that can be secured
• Live in a location that can receive a high-speed internet connection
  

Preferred Qualifications:

• Medical claims review or claims processing experience
• Demonstrated attention to detail
  

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $16.00 to $31.44. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.




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.