Position Description:Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives. As one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high - quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work.What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.Primary Responsibilities: Manage administrative intake of members or the admission / discharge information post notificationWork with hospitals, clinics, facilities and the clinical team to manage request for services from members and / or providersManage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census rolesReceive care coordination notification cases for non - clinical assessment / intervention and provide appropriate triage.Review requests for adverse determination, approval notification and processing notification requirementsAssist the clinical staff with setting up documents / triage cases for Clinical Coverage ReviewHandle resolution / inquiries from members and / or providers that may include: Benefit and Eligibility information, Billing and Payment issues, Customer material requests, Physician assignments, Authorization for treatment, Explanation of Benefits (EOB), Verifying appropriate ICD - 9 and CPT coding usageCommunicating in Spanish with members
Required Qualifications:High School Diploma / GED2+ years of Customer Service experience analyzing and solving customer problems1+ years of experience working in an office setting using the telephone and computer as the primary instruments to perform job dutiesExperience using a computer and Microsoft Office (Word, Excel and Outlook)Comfortable working Monday - Friday 9:00 AM - 6:00 PMMust be bilingual in English and Spanish and able to communicate professionally with membersMust be able to travel 20% within the local areaPreferred Qualifications:Healthcare experienceHealth education experienceMedical Terminology knowledgeMedicaid knowledgePrevious experience working in a Call Center Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high - risk pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.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.Keywords: UHG, Edison, NJ, customer service, healthcare, telephonic, patient interaction, field based, advocacy
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.