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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Under the supervision of the Medical Claims Review (MCR) Supervisor, this position is responsible for processing targeted projects of Utilization Management (UM) Inventory. Associate MCR Coordinator is responsible for coordinating processes with MCR UM Coordinators and UM Nurses as needed. MCR Associate Coordinator is responsible for providing clerical support to WellMed clinical staff for their medical necessity review process. Associate MCR Coordinator is expected to maintain production and quality standards.
This position is full time, Monday - Friday. Employees are required to have flexibility to work our normal business hours of 7:00am - 4:00pm. It may be necessary, given the business need, to work occasional overtime. Employees are required to work 3 days onsite and 2 days from home.
We offer 3-4 weeks of paid training. The hours during training will be 7am to 4pm, Monday - Friday. Training will be conducted onsite.
If you are within 30 miles of San Antonio, TX, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.
Primary Responsibilities - Research and resolve targeted UM inventory accordingly to meet productivity and quality standards to include:
- Claims reports with reconciliation needs
- Information received through Right Fax
- Information received through email
- Or any other methods of receipt (phone calls, etc.)
- Coordinates initial screening for UM claim reviews through claim queue
- Prepares administrative files for MCR Coords, Medical Directors and MCR Nurses
- Documents and follows-up on all assigned inventory, utilizing on-line systems and procedures, according to established guidelines
- Maintains knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
- Utilize experience and judgement to plan, accomplish goals and effectively resolve each assigned task
- Performs all other related duties as assigned
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
- Must be 18 years or older
- 1+ years managed care experience in Prior Authorization or Claim Review
- Familiarity with Microsoft Office applications, i.e. Excel, Access
- Ability to work our normal business hours of 7:00am - 4:00pm. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications
- Medical Terminology
- ICD-9/ICD-10 and CPT knowledge
Telecommuting Requirements
- Reside within 30 miles of San Antonio TX
- 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
- Ability to organize, prioritize and communicate effectively.
- Ability to provide excellent customer service to a varied customer base
- Ability to navigate multiple systems
- Ability to work in a fast-paced environment
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
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.
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