Clinical Administrative Coordinator

Optum; Albuquerque (NM); On-site; USD 25,000 - 44,000; Full time

Job summary

Optum is seeking a Clinical Administrative Coordinator in Albuquerque, NM to streamline the referral process and support the clinical team. This full‑time role requires strong organizational skills and the ability to handle high call volumes with accuracy and courtesy.

You will coordinate internal and external referrals, process prior authorizations, manage member intake and records, and assist with document triage for Clinical Coverage Review.

Qualifications

• Experience in healthcare or health insurance preferred.
• Experience in hospital/clinic setting preferred.
• Knowledge of ICD-9 and CPT codes is beneficial.

Responsibilities

• Manage the internal/external referral process and daily referral reconciliation gathering required information and documents needed, working them accordingly in compliance with established timelines
• Manage administrative intake of members
• Maintains department records as requested by supervisor, department director and/or other regulatory agencies
• Maintains area according to the following duties; Receives all requests for exam (CD) - check out; Processes requests and prepares CD check-out requests according to protocol; Receives and processes in the RIS all outside facility in-coming exams; Down-load all outside facility exams in PACS; Prepares and processes all outside facility exams for return to facility or patient; Processes in all returned exams; Maintains CD files and purges outdated exams; Requests pertinent prior exams for all modalities per protocol
• 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
• Performs all other related duties as assigned
• Intermediate level of proficiency in Microsoft Office applications including Excel, Word and Outlook

Skills

Customer service

Communication skills

High call volume handling

Tools

Excel

Word

Outlook

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Clinical Administrative Coordinator (2376549)

Clinical Administrative Coordinator - 2376549

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 startCaring. Connecting. Growing together.

Under the supervision of the Referral Management Center Supervisor, theClinical Administrative Coordinatorposition are responsible for the daily coordination of referral processes and other duties as assigned.

Location: 5150 Journal Center Blvd. NE, Albuquerque, NM 87109. It may be necessary, given the business need, to work at the two other locations in Albuquerque.

This position is full-time, Monday - Friday. Employees are required to have flexibility to work our normal business hours of 8:00am - 5:00pm MST.

Primary Responsibilities:

• Manage the internal/ external referral process and daily referral reconciliation gathering required information and documents needed, working them accordingly in compliance with established timelines
• Manage administrative intake of members
• Maintains department records as requested by supervisor, department director and/or other regulatory agencies
• Maintains area according to the following duties;
  • Receives all requests for exam (CD)- check out
  • Processes requests and prepares CD check-out requests according to protocol
  • Receives and processes in the RIS all outside facility in-coming exams
  • Down-load all outside facility exams in PACS
  • Prepares and processes all outside facility exams for return to facility or patient
  • Processes in all returned exams
  • Maintains CD files and purges outdated exams
  • Requests pertinent prior exams for all modalities per protocol
• 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
• 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.

• Intermediate level of proficiency in Microsoft Office applications including Excel, Word and Outlook

Preferred Qualifications:

• 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
• Previous experience working in radiology
• A clerical or administrative support background
• Previous experience working within an Electronic Health Record (EHR) system
• Demonstrated ability to manage and respond effectively to high call volumes
• Working knowledge of medical terminology and clinical documentation

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

California Residents Only:The hourly range for California residents is$18.00 to $32.00per hour. 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.

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.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.