Clinical Admin Coordinator– Remote​/No Degree RQD UnitedHealthcare Group

Position: Hiring: Clinical Admin Coordinator– Remote/No Degree RQD UnitedHealthcare Group

Overview

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. 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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Team/Process Context QIO fast track appeals team – Supports Fax Operations with Appeal Notification and determination fax work. 25 staff nationally positioned in all time zones. Normal appeal volumes range 400-700 new appeals per day for the business. Staff at minimum handle 14 new appeals per hour and 25 determination letters per hour to meet expectations. The Medicare QIO fast track appeal process has a regulatory letter requirement with a same-day turnaround time for new appeals. Job Function Positions in this function include those responsible for supporting the Intake function of members QIO appeal notification requests through fax or email, with notation of receipt of appeal status in the member’s case. Includes communicating requests from providers to clinical staff. This function includes intake, notifications and fax archiving work. Work Schedule This position is full-time, Monday – Friday. Flexibility to work any of our 8-hour shift schedules during normal business hours of 8:30 am – 5:30 pm PST. Occasional weekends may be necessary based on business need. We offer 6 weeks of training from 8:30 am – 5:30 pm PST, Monday – Friday. Primary Responsibilities

• Serve as primary contact for providers or members regarding medical / behavioral / clinical services or benefits
• Extract and review fax requests for medical or clinical services
• Receive faxes requesting medical or clinical services or benefits information
• Review fax information and apply job aid tools to identify procedures, gather information, and assess urgency
• Access electronic member files using policy or r
• Determine member eligibility
• Follow protocols to task requests appropriately
• Navigate between computer screens and platforms to research information (medical, clinical, or benefits)
• Review requests from providers regarding case status
• Reference automated job aid tools to research relevant rules, regulations, or procedures
• Learn computer system and process changes and incorporate into daily work
• Contact internal resources to clarify information and identify appropriate resource to respond to medical requests
• Document fax history information into relevant computer system
• Enter medical request data into relevant computer system
• Follow standard procedures to complete requests
• Request medical review via relevant computer system as needed
• Reply to providers by fax to advise on status of a request

Qualifications

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age or older
• Customer service experience analyzing and solving customer problems
• Ability to create, edit, save and send documents using Microsoft Word and Excel
• Ability to navigate a PC to open applications, send emails, and conduct data entry
• Ability to work hours 8:30 am – 5:30 pm PST, Monday – Friday

Preferred Qualifications:

• Experience in the Healthcare Industry
• Experience with Healthcare Insurance
• Experience in a Hospital, Physician’s Office, or Medical Clinical setting
• Clerical or administrative support experience
• Knowledge of Medical Terminology to communicate with members and providers
• Experience with ICD-9 and CPT codes
• Experience with Medicare and/or Medicaid Services
• Experience in a call center and fax center environment
• Ability to work from home in a private setting; no lifting or strenuous activity required

Telecommuting Requirements

• Maintain security of company sensitive documents
• Have a dedicated work area separated from living areas to ensure privacy
• Live in…

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