Health Care Admin Representative – San Juan, PR

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

The Clinical Admin Coordinator from the Home and Community-based Services department are 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 outbound 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.

Primary Responsibilities:

• Resolves customer service inquiries which could include: entering authorizations, provide status of an existing authorizations and determining if authorizations is require
• Determine whether authorizations are required for requested medical services
• Communicate with providers and patients to provide updates on the status of their auth request
• Prioritizes and organizes own work to meet agreed upon deadlines
• Serve as primary point of contact for providers or members regarding medical/behavioral/clinical services or benefit
• Extract and review fax requests for medical or clinical services
• Communicate with clinical team to ensure provider receives a response when necessary

*** ENGLISH PROFICIENT ASSESSMENT WILL BE REQUIRED AFTER APPLICATION ***

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:

• 1+ years of experience in healthcare environment
  
• 1+ years of experience in production environment 
• 1+ years of experience analyzing and solving customer problems in an office or customer service environment
• Ability to utilize complex database systems and production platforms simultaneously.
• Experience working with Microsoft Word (creating, editing, saving documents) and Microsoft Excel (creating, editing, saving spreadsheets)
• Experience working with a PC and windows applications
• Professional English proficiency
• Willing or ability to work 40 hours / week during standard business operating hours Monday – Friday 7am – 8pm AST (It may be necessary, given the business need, to work occasional overtime on weekends and holidays)
• Ability to undergo cross-training in accordance with business needs

Preferred Qualifications:

• Experience working with ICD-9/10 and HCPC coding system
• Knowledge of Managed Care/ Medicaid / Medicare / Commercial rules and state regulations
• Strong Analytical Skills and Problem Solving
• Ability to work independently and as a team player along with other departments.

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.