Clinical Administrative Coordinator - Remote in MST OR CST

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.
Under the supervision of the Network Operations Supervisor, this position is responsible for the daily coordination of Network Operations processes in the Intake Call Center. This position serves as the initial intake of pre - service requests, claim reviews and inpatient hospital coordination and diabetic supplies. Coordinates Network Operations processes with Medical Directors, Network Operations Nurses, hospitals, physicians and other various departments. Provides clerical support to clinical staff in their medical necessity review process. The Intake Coordinator is expected to maintain production and quality standards.

This position is full-time (40 hours / week), 8-hour shift Sunday - Saturday, 9:00 am - 7:00 pm with varying shifts to support our 24 hour a day, 7 days per week operations. Employees must be able to work any shift in a 24-hour period, all days of the week, including weekends and / OR evening and overnight shifts. These hours will be worked in the CST time zone.

Training will be conducted Monday - Friday for the 6-8 week program from 8:00 am - 4:30 pm CST. Training will be conducted virtually from home. All employees will be required to be on camera every day of training, including when training module assessments are completed.

If you are located in CST OR MST Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
• Providing excellent customer service, including the ability to handle escalated callers
• Determining authorization OR notification requirements
• Preparing authorization cases for Medical Directors, Network Operations Nurses and Case Managers
• Providing administrative approvals (depends on the line of business)
• Handling expedited authorizations, authorization updates and status checks
• Confirming member eligibility
• Outreaches to providers and / OR Patient to complete authorization requests and prescriptions
• Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
• Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
• Non-Clinical staff is not responsible for conducting any Network Operations activity that requires interpretation of clinical information
• Performs all other related duties as assigned

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
• Must be 18 years of age OR older
• 1+ years of combined OR related experience in a healthcare, call center, and / OR customer service setting using the telephone and computer as the primary instrument to perform job duties
• Proficiency with Microsoft Office Word (create and maintain documents), Microsoft Excel (create and maintain spreadsheets) and Microsoft Outlook (email and calendaring)
• Ability to work 8-hour shift Sunday - Saturday, 9:00 am - 7:00 pm CST (shifts vary to support our 24hr 7 days a week operation)

Preferred Qualifications:

• Medical Terminology
• ICD-10 and CPT Knowledge

Telecommuting Requirements:

• Reside within CST OR MST Time Zone
• 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

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