UnitedHealth Group Clinical Administrative Coordinator - Tonawanda, NY in Tonawanda, New York

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.

Like you, UnitedHealth Group is strong on innovation. And like you, we'll go the distance 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 a chance to make an impact.

Employees in this position include those responsible for initial Triage of members, Administrative Intake of members or managing the Admission / discharge information post - notification, and working with hospitals and the Clinical team. Function includes managing Incoming calls, managing requests for services from Providers / members, providing information on available Network services and transferring members as appropriate to Clinical staff. Also manages the Referrals process, processes Incoming and Outgoing Referrals, and Prior Authorizations. This function also includes Intake, Notification and Census roles.

Join us today and we can provide you with meaningful challenge that can result in a strong sense of impact and fulfillment. It's truly an opportunity to do your life's best work.SM

Primary Responsibilities:

  • Respond to Incoming Provider and Enrollee calls

  • Resolve Customer Service inquiries

  • Provide excellent Customer Service to both Providers and Enrollees.

  • Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.

  • Receives Care Coordination notification cases for non - clinical assessment / intervention and provides appropriate triage

  • Processes out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate products

  • Processes notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issues

  • Determines benefit coverage issues based on employer group contracts

  • Sets up / documents/triages cases for (CCR) Clinical Coverage Review

  • Ensures all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicable

  • Processes letters within DOL time frames

  • Verifies appropriate ICD - 10 and CPT coding usage

  • Communicates to providers and members benefit determinations within DOL time frames

  • Assist with faxes and emails

  • Moderate work experience within own function

  • Some work is completed without established procedures

  • Basic tasks are completed without review by others

  • Supervision / guidance is required for higher -level tasks

  • Other duties as assigned by manager and / or director

Required Qualifications:

  • High School Diploma or GED

  • 1+ years of professional experience in an office / customer service environment

  • Previous experience working within the Healthcare Industry

  • Previous experience working with Microsoft Word (ability to create, edit and save), Microsoft Excel (ability to create, edit and save), and Microsoft Outlook (ability to create, edit and save)

  • Computer experience including, but not limited to, ability to learn new computer system applications

  • Flexibility to work outside standard hours of operations due to changing business needs

Preferred Qualifications:

  • Bachelor's Degree or higher

  • Professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties, or Customer Service experience analyzing and solving customer's problems

  • Experience working within a Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD - 10 and CPT codes, Medicare and / or Medicaid Services, Call Center environment

  • Professional experience in a Clerical or Administrative support related role

  • Bilingual fluency in English and Spanish

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work. SM

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, Clinical, Healthcare, Administrative, UnitedHealthcare, Tonawanda, New York