Under the supervision of the Medical Claims Review (MCR) Supervisor, this position is responsible for processing targeted projects of Utilization Management (UM) Inventory. Clinical Administrative Coordinator is responsible for coordinating processes with MCR UM Coordinators and UM Nurses as needed. Clinical Administrative Coordinator is responsible for providing clerical support to WellMed clinical staff for their medical necessity review process. Clinical Administrative Coordinator is expected to maintain production and quality standards.

This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 7:00 AM - 4:00 PM. 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 7:00 AM - 4:00 PM from Monday - Friday. Training will be conducted onsite.

If you are within 30-mile commutable distance to the office at 19500 W Interstate, 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 Coordinators, 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 of age OR older
• 1+ years of managed care experience in Prior Authorization OR Claim Review
• Familiarity with Microsoft Office applications (i.e., Microsoft Excel, Microsoft Access)
• Ability to work any shift between the hours of 7:00 AM - 4:00 PM from Monday - Friday

Preferred Qualifications:

• Medical terminology
• ICD - 9 / ICD - 10 and CPT knowledge

Telecommuting Requirements:

• Reside within 30-mile commutable distance to the office at 19500 W Interstate, 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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