Clinical Administrative Coordinator

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. 
 
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 do at the minimum of  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.

Positions in this function includes those responsible for supporting the Intake function of members QIO appeal notification requests through fax or email with notation of the receipt of appeal status in the member’s case. Includes communicating requests from provider to clinical staff. This function includes intake, notifications and fax archiving work.

This position is full time Employees are required to have flexibility to work during our normal business hours of 40 hour week -either 8 hour shift Tuesday-Saturday or 10 hour shift Wednesday-Saturday PST time zone during operating hours of 7am-7pm. It may be necessary, given the business need, to work occasional overtime.

We offer 6 Weeks of training  the training hours / schedule 8:30 am  – 5:30 pm PST Monday -Friday

 

Primary Responsibilities:

• Serve as primary point of 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/behavioral/clinical services or benefits information (e.g., from providers)
• Review fax information and apply job aid tools via the computer to identify appropriate procedures needed to understand requests, gather necessary information, and assess urgency-Access electronic member files using policy or id number
• Determine member eligibility
• Follow protocols to task requests appropriately
• Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)
• Review requests from providers regarding case status
• Reference automated job aid tools via computer to research relevant rules, regulations, or procedures
• Learn computer system and process changes and updates and incorporate into daily work
• Contact internal resources if necessary to clarify information-Identify appropriate resource (e.g., doctor, resource, contracted provider) 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

 

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: 

• HS Diploma / GED 
• Must be 18 years of age OR older
• Customer service experience analyzing and solving customer problems 
• Must be able to create, edit, save and send documents utilizing Microsoft Word and Excel 
• Must be able to navigate a PC to open applications, send emails, and conduct data entry
• Flexibility to work during our normal business hours of 40 hour week -either 8 hour shift Tuesday-Saturday or 10 hour shift Wednesday-Saturday PST time zone during operating hours of 7am-7pm. It may be necessary, given the business need, to work occasional overtime.

 

Preferred Qualifications:

• Experience working within the Healthcare Industry
• Experience working with Healthcare Insurance
• Experience working in a Hospital, Physician’s Office, or Medical Clinical setting. 
• Professional experience in a clerical or administrative support related role 
• Working Knowledge of Medical Terminology to communicate with members and providers 
• Experience working with ICD-9 and CPT codes 
• Experience working with Medicare and / OR Medicaid Services 
• Experience working in a call center and fax center environment
• Ability to work from home in a private setting, while sitting or standing to process the intake of faxes or emails. No lifting or strenuous activity is required 

 

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.

 

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

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 – $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

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.

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

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