Clinical Administrative Coordinator

4 weeks ago


San Antonio, Texas, United States Optum Full time

Optum Clinical Administrative Coordinator Job Summary

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. We are seeking a highly skilled Clinical Administrative Coordinator to join our team in a full-time role. As a Clinical Administrative Coordinator, you will play a critical role in processing Utilization Management (UM) Inventory and providing clerical support to our clinical staff for their medical necessity review process.

Key Responsibilities:

  • Research and resolve UM inventory accordingly to meet productivity and quality standards.
  • Coordinate initial screening for UM claim reviews through claim queue.
  • Prepare administrative files for Medical Directors, UM Nurses, and Case Managers.
  • Contact provider offices to obtain clinical information for medical review by a clinician.
  • Document and follow up on all assigned inventory, utilizing online systems and procedures, according to established guidelines.
  • Maintain knowledge of various health plan partner benefits, networks, CMS regulations, and health plan partner policies.
  • Utilize experience and judgment to plan, accomplish goals, and effectively resolve each assigned task.
  • Receive and respond to telephone calls through the UM Phone Queue, as needed.

Requirements:

  • High School Diploma / GED or equivalent experience.
  • Must be 18 years of age or older.
  • 1+ years of experience in a hospital, physician's office, or medical clinic setting.
  • 6+ months of experience with using Medical Terminology.
  • 6+ months of experience with working in an environment that is based on meeting metrics and daily goals.
  • Proficiency with Microsoft Office applications (i.e., Microsoft Excel, Microsoft Access).
  • Ability to work onsite at our office location.
  • Ability to work any 10-hour shift for 4 days between the hours of 9:00 AM - 8:00 PM or 7:00 AM - 6:00 PM.

Preferred Qualifications:

  • 2+ years of experience in a hospital, physician's office, or medical clinic setting.
  • Experience in working with healthcare insurance.
  • A clerical or administrative support background or experience with working in a call center environment.

Soft Skills:

  • Exceptional ability to organize, prioritize, and communicate effectively.
  • Ability to navigate multiple systems.
  • Ability to work in a fast-paced environment.

Why Optum?

At Optum, we believe everyone - of every race, gender, sexuality, age, location, and income - deserves the opportunity to live their healthiest life. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes. We are an Equal Employment Opportunity / Affirmative Action employer and welcome applications from diverse candidates.



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