UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Associate Clinical Administration Coordinator - Wausau, WI-316348
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description
UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare, what you do matters. It's that simple...and it's that challenging.
In providing consumer-oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Associate Clinical Administration Coordinator - Wausau, WI
Primary Responsibilities:
- Provides the best customer service by answering telephone or e-mail inquiries regarding individual status of requests of providing information in an efficient and pleasant manner.
- Provides a variety of administrative and technical duties to assigned department or manager.
- Organizes work by reading, routing correspondence, collecting information and initiating telecommunications.
- Creates reports by collecting, sorting and analyzing data.
- Organizes filing, faxing, copying, and general administrative and technical duties when necessary.
- Oversees case reviews until finalized, involving internal and external contacts per department guidelines.
- Requests and screens Plan Language received from Calligo and the Health Plan Database for input into each specific case.
- Maintains workflow by acknowledging special procedures/requirements for specific accounts.
- Verifies benefit information by utilizing Health Plans Database or requesting copies of actual plan.
- Knowledge of Claim P&P's for specific Claim Consult reviews, such as Cosmetic, Obesity, etc.
- Documents all Claim Consult cases in FYAA with benefit determination.
- Knowledge of which Claim Consult cases need a nurse review, based on specific criteria and specific Plan Language.
- Understands which Claim Consults require a RUSH review, such as Stop Loss and High Priority Accounts.
- Recognizes concerns by gathering pertinent documentation and referring an issue to appropriate staff.
- Assists with completion and determination of pre-authorization and actual claims by generating letters and appropriate documents specifically related to the Claim Consult determination.
- Maintains operations by following policies and procedures according to DOL and HIPAA regulations; make suggestions for improving processes and efficiencies.
- Maintains customer confidence and protects operations by keeping information confidential.
- Contributes to team effort by accomplishing related results as needed.
Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
Qualifications Qualifications:
- Previous medical experience is desired.
- Experience using Medical terminology.
- Ability to converse fluently using appropriate medical terminology.
- Above average verbal, written and interpersonal communication skills are essential. Evidence of the ability to work cooperatively and be tactful and assertive with medical providers.
- Ability to make sound judgments within department guidelines and function cooperatively as a team member.
- Ability to organize work, set priorities and establish an efficient, well-organized work assignment.
- Evidence of sound analytical, problem-solving and decision-making skills for resolving customer concerns, processing and workflow issues.
- Evidence of the ability to work accurately and efficiently in a results-oriented environment with high standards and statistical monitoring of performance.
- Computer experience related to claim handling or health care administration preferred.
- Working knowledge of personal computers and/or mainframe systems gained through previous work experience or related course work.
- Demonstrated ability to read, write and understand complex medical terminology and procedures.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. All candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
