Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission / discharge information post - notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers / members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles. *Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.
- Manage 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
- This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours
- Moderate work experience within own function
- Some work is completed without established procedures
- Basic tasks are completed without review by others
- Supervision / guidance is required for higher level tasks
- High School Diploma / GED or higher
- Experience with Microsoft Word, Excel and Outlook (ability to edit, create, save and send documents, spreadsheets, and emails)
- Experience working within the health care industry and with health care insurance
- Experience working in a hospital, physician's office or medical clinic setting
- Knowledge of ICD - 9 and CPT codes
- Experience working in a call center
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.
Keywords: clinical, administrative, coordinator