Job: Clinical Administrative Coordinator - San Antonio, TX

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Jobing Description

Position Description:

Clinical Administrative Coordinator is part of the Medical Claims Review (MCR) team, and performs retrospective review of claims without an authorization from different regions around the U.S. Job assignments vary, depending on which region you are working, requiring flexibility. There are situations and issues which are diverse and ambiguous, requiring careful evaluation, consideration, and reasoning.

Position Responsibilities:

• Respond to incoming provider and enrollee calls


• Resolve customer service inquiries which could include:
  
  
  
  • Enter notifications, Providers status of an existing notification and determining if notification is required
  
  
  • Complete notification wizard along with ICD-9 and CPT coding
  
  
  • Provide excellent customer service to both providers and enrollees
  
  
  • Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance
  
  
  • Assist with faxes and emails
  
  
  
  


• Under general supervision, collect, process, and monitor routine to moderately complex retrospective claims and healthcare services data, and verifies benefits


• Input and process retrospective reviews per guidelines and according to defined time and accuracy standards (have minimum production volume each day)


• Determine propriety of outpatient services based on consistent application of decision support system


• Maintain files and documentation of all related materials utilized for retrospective review


• Document cost savings and maintains related reports

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 simpleand 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.


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.


When you are in the business of health care, you're in the business of people. At UnitedHealth Group we want every customer experience to be distinctly personal. The challenge is complex. When people call us for help, their focus is on getting the best care possible. We help them understand their benefits and their options. This part of their lives matters a lot to them and it matters just as much to us. Our customer service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care.

Skills / Requirements

Requirements:

• High School Diploma or GED is required


• 1+ years telephonic customer service experience is required


• Data entry experience; the ability to talk & type at the same time is preferred.


• Intermediate months Microsoft Office (Word, Excel & Outlook) is required


• Knowledge of medical terminology and coding experience are strongly desired

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. In addition, employees in certain positions are subject to random drug testing.