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Clinical Operations Coordinator
2 months ago
Are you driven by a desire to make a meaningful impact in healthcare? At OptumCare, we believe that transforming lives begins with the values we uphold and the dedication we exhibit in our roles. The Clinical Operations Coordinator plays a crucial role in supporting the Utilization Management (UM) department by overseeing various administrative tasks related to UM organization determinations and appeal processes.
Key Responsibilities:
- Conduct data entry, maintain organized filing systems, and track timelines and statuses of case files while ensuring timely correspondence with patients and providers.
- Analyze denial cases to ascertain whether decisions pertain to retrospective claims or prospective services, categorizing them as necessary or not.
- Oversee system approval queues, ensuring that all member letters are printed and dispatched by the end of the business day.
- Prepare and send out envelopes and letters in accordance with UM policies.
- Log and manage appeal requests from health plans or Quality Improvement Organizations (QIO), conducting thorough research to provide the necessary information.
- Collaborate with the claims department to redirect appeal requests related to claims.
- Generate analytical reports for departmental review utilizing the data entry system.
- Assist with CMS organization determination reports as required.
This role is situated in a high-volume, customer-centric environment, necessitating efficiency, productivity, and attention to detail when interacting with members via phone. Flexibility in scheduling, including evening hours and weekends, is essential.
At OptumCare, your contributions will be acknowledged and rewarded in a challenging environment that provides clear guidance for success in your role while offering opportunities for professional growth in other areas of interest.
