Clinical Admin Coordinator

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Employer - UnitedHealth Group
Category - hr-admin-personnel
Job title - Clinical Admin Coordinator

Job Description
Job Family Description Positions in this family include those reposnsible for functions in areas such as health services, clinical services and delivery of clinical care. Job Function Description Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles. General Job Profile
Moderate work experience within own function.
Some work is completed without established procedures.
Basic tasks are completed without review by others.
Supervision/guidance is required for higher level tasks. Job Scope and Guidelines
Applies knowledge/skills to activities that often vary from day to day.
Demonstrates a moderate level of knowledge and skills in own function.
Requires little assistance with standard and non-standard requests.
Solves routine problems on own.
Works with supervisor to solve more complex problems.
Prioritizes and organizes own work to meet agreed upon deadlines.
Works with others as part of a team. Additional Scope and Guidelines Not Applicable Minimum Educational Background
High school education or equivalent experience. Licenses and Certifications Code Description Functional Competencies Functional Competency & Description Proficiency Level CLA_Receive Medical/Behavioral/Clinical Services or Benefits Requests C) Fully Proficient
Serve as primary point of contact for providers or members regarding medical/behavioral/clinical services or benefits
Extract and review fax requests for medical or clinical services
Receive calls requesting medical/behavioral/clinical services or benefits information (e.g., from providers or members)
Receive electronic referral form requests for medical/behavioral/clinical services
Utilize phone system to respond to and transfer calls to appropriate individuals
Ask callers standard questions to understand requests, gather necessary information, and assess urgency
Access electronic member files using policy or id number
Determine member eligibility
Follow protocols to task requests appropriately
Check procedure codes against notification requirements and benefit coverage to determine next steps
Reference automated job aid tools via the computer to identify appropriate procedures when needed CLA_Research Information to Respond to Medical/Behavioral/Clinical Services or Benefits Re C) Fully Proficient
Access claims information
Review and interpret call history documentation (e.g., case notes)
Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)
Take calls and questions from members and/or providers regarding case status
Determine whether authorizations are required for requested medical services
Reference automated job aid tools via computer to research relevant rules, regulations, or procedures
Learn computer system and process changes and updates and incorporate into daily work
Contact internal resources if necessary to clarify information
Identify appropri

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Job Location Bengaluru, Karnataka
Date Posted 09 Aug 2019
Employer Email --No Email
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