Clinical Administrative Coordinator

Sacbar; Dallas, Northern (TX, KY); Hybrid; USD 25,000 - 44,000; Full time

Benefits offered by this job

Comprehensive benefits

401k and stock purchase program

Job summary

UnitedHealth Group is seeking a Clinical Administrative Coordinator for the Optum Care division. This national remote role involves triaging clinical claim reviews, preparing cases for nurse review, and coordinating with claims operations and clinical teams.

You will verify claim data, member eligibility, and prior authorization details in the system while supporting letters to providers. The position is full-time with standard hours 8:00 am–4:30 pm and occasional overtime.

Qualifications

• Requires High School Diploma or GED or equivalent work experience.
• Typing 45 words per minute or faster and basic computer skills are required.
• 1+ year of medical claims review or processing experience.

Responsibilities

• Access and review claims information in the claims payment system.
• Verify member eligibility and health plan details.
• Determine prior authorization requirements and inpatient utilization.
• Prepare and send letters to providers per nurse instruction.
• Support team with deadlines and process updates.

Skills

Typing 45 WPM

Medical claims review

MS Office

Education

High School Diploma or GED

Tools

Microsoft Word

Microsoft Outlook

Job description

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.

The Optum Care Clinical Administrative Coordinator team is responsible for the initial triage of clinical claim reviews, administrative preparation of cases for nurse review and working with others in claims operations and clinical teams. The initial triage includes using departmental resources to validate the appropriateness of the case for the Medical Claim Review nurses. The Clinical Administrative Coordinator is responsible for verifying claim information, member eligibility, related utilization management and prior authorization information in the claims payment system. This role includes managing clinical letters as directed by the nurses.

This position is full-time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 4:30 pm. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of paid training. The hours of training schedule might adjust based on training availability.

Primary Responsibilities:

• Access claims information in the claims payment system
• Determine if Medical Claim Review is required for the service(s) using department resources (e.g., job aids, prior-authorization lists, MCR Code List)
• Verify member eligibility
• Determine health plan and network
• Verify prior authorization and/or inpatient utilization review information in claims payment system
• Create and send letters to providers as directed by nurses
• Follow standard procedures to complete work, including departmental job aids and policies
• Learn computer system and process changes and updates to incorporate into daily work
• Navigate between computer screens and platforms to research information (e.g., medical, clinical or benefits information)
• Applies knowledge/skills to activities that often vary from day to day
• Works with others as part of a team
• Prioritize and organize work to meet deadlines
• Work with supervisor to solve more complex problems
• Other duties assigned by leadership

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 or equivalent work experience
• Must be 18 years of age or older
• Ability to type 45 Words Per Minute
• Computer literacy, Microsoft Office Suite (Microsoft Word & Microsoft Outlook)
• 1+ years of medical claims review OR claims processing experience
• Ability to work full-time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 4:30 pm. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• 2+ years administrative experience in healthcare setting

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.

Soft Skills:

• Demonstrated attention to detail

*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 salary for this role will range from $18 - $32 hourly 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.