Optum CA is seeking an Associate Clinical Administrative Coordinator to join our team in Arcadia, CA. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.
At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
This position is full-time, Monday - Friday. Employees are required to work during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime and weekends. Our office is located at 440 E Huntington Dr, Suite 200, Arcadia, CA. Employees are required to work Monday, Tuesday, and Friday onsite and Wednesday to Thursday from home.
We offer 2 weeks of on-the-job training. The hours during training will be 8:00am - 5:00pm, Monday - Friday.
If you are within commutable distance to the office at 440 E Huntington Dr, Suite 200, Arcadia, CA, 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:
Performs effective prospective and concurrent review of requested services according to established guidelines and timeframes
Documents members' service benefits by contacting the appropriate health plans as needed
Directs providers/members to contracted provider network and facilities
Processes appropriate authorizations for HMO/PPO clients as specified in the Optum Care procedures
Prints and mails authorizations to providers, patients, HMOs and facilities as needed
Assists and monitors in the processing of referrals. Enters, updates and closes referrals daily while assuring that appropriate internal/external referral providers are utilized, members are eligible and have benefits coverage, correct CPT/ICD codes have been entered, accurate records of all dates and other required fields are entered, supporting clinical data for the referrals is entered, and all urgent referrals are processed within the designated timeframe
Processes referrals for durable medical equipment and coordinates home health services according to established policies, procedures and guidelines
Processes elective surgical requests including the coordination of surgery dates and notification of inpatient team, Hospitalist or Care Manager when appropriate
Coordinates, identifies and routes referrals that require review to licensed Care Management staff who arranges outside physician medical review as appropriate
Acts as a resource to other coordinators, staff and providers by resolving issues and responding to requests in a timely and effective manner
Works with Patient Services regarding member concerns
Processes referrals for inter-facility transfers using pre-established guidelines
Processes after-hours emergency/urgent care logs/lists as needed
Collects and prepares medical records for review when appropriate or as requested
Assists with answering telephones and maintaining files, logs or other reports
Uses, protects, and discloses Optum Care patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
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 customer service experience analyzing and solving customer problems
Must be able to create, edit, save and send documents utilizing Microsoft Word and Microsoft Excel
Must be able to type and talk at the same time and navigate through multiple screens
Ability to travel up to 25% of the time
Ability to work Monday - Friday, during our normal business hours of 8:00am - 5:00pm, including the flexibility to work occasional overtime and weekends, based on the business need
Preferred Qualifications:
Experience working within the health care Industry and with health care insurance
Experience working with Medicare and/or Medicaid Services
Experience working in a metric-driven work environment
Call Center experience
Clerical or administrative support background
Knowledge of ICD-9 and CPT codes
Telecommuting Requirements:
Reside within a commutable distance to the office at 440 E Huntington Dr, Suite 200, Arcadia, CA
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
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California Residents Only: The hourly range for this is $16.00 - $28.27 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
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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