You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Combine two of the fastest – growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making Healthcare data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.SM

The Patient Care Coordinator is responsible for coordinating and maintaining a positive customer experience while performing Referral and Prior Authorization functions. Be able to interact in a friendly, professional manner. Attention to detail and the ability to work well under pressure is essential. Also, must be able to function effectively in an environment where it is necessary to perform several tasks simultaneously.

This position is full-time (40 hours/week) Monday to Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:30am – 5:00pm CST. It may be necessary, given the business need, to work occasional weekends.
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities
Receives and documents, telephonic, and electronic requests for referrals from Primary Care Physicians, Specialists and Ancillary providers.
Contacts review organizations and insurance companies to obtain prior approval requirements and submit appropriate documentation.
Verifies member eligibility and basic benefit coverage levels including obtaining information on coordination of benefits and third party liability as appropriate.
Maintains a current working knowledge of all Health Plan carrier requirements for referral request authorizations and approval path requirements. (Pre-Determinations and Peer to Peers)
Utilizes computer resources to determine provider networks.
Per referral guidelines evaluates each referral request to ensure the referral request including codes, place of service, service type, provider and all required medical information is available for submission to insurance carriers.
Investigates and obtains from providers, missing medical information required for referral submission.
Applies knowledge and application of ICD-10 and CPT coding, as well as medical terminology for appropriate communication with physicians and providers
Performs data entry/processing of referral requests through the EPIC system, and edits referral notes with appropriate information as outlined per department procedures.
Functions as a resource to physician/provider offices regarding steerage, referral process questions and education on Health Plan authorization submission requirements.
Provides source of referral and prior approval requests with timely notification of approval or denial decisions through designated communication routes.
Resources Sr Referral Specialist or Supervisor/Manager for review of complex referral requests and issues
Works with Physician offices to provide ongoing education regarding referral process and requirements.
Provides input to Sr Referral Specialist and Supervisor/Manager regarding improvements to operating practices
May assist with training of new staff
Other 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 (or higher)
1+ years of experience in a clinical or business setting
Experience working with Microsoft Word (creating, editing, saving documents)
Experience working with a PC and windows applications, with the ability to learn new and complex systems
Must have knowledge and understanding medical terminology
Previous experience with processing full-cycle prior authorizations with Health Plans

Telecommuting Requirements
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Ability to keep all company sensitive documents secure (if applicable)
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
Experience working in a fast paced environment where attention to detail is required
Experience with interacting with members to discuss the outcome of provider searches
Demonstrates organizational and problem-solving skills
Understanding of fundamental health-care related medical terminology, programs or services
Experience applying specific policies or standards to daily work to assure compliance with relevant regulations
Be able to multitask and manage your time well to meet deadlines in a high production time based environment

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people’s lives. This is where it’s happening. This is where you’ll help solve the problems that have never been solved. We’re freeing information so it can be used safely and securely wherever it’s needed. We’re creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $15.00 – $25.19. The salary range for Connecticut / Nevada residents is $15.77 – $27.79. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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

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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