Determination Letter Coordinator – 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 Administrative Coordinator (CAC) is a multi-faceted role within Optum Health Risk Operations that encompasses different levels of administrative support. The Clinical Administrative Coordinator serves as a bridge, allowing for a seamless transition for members and providers moving through the continuum of care. This role can include initial triage of members for possible transition to clinical staff, managing admission and discharge census information, serving as a point of contact for facilities and clinical teams, telephonic engagement with our members and providers, providing information on available network services, managing the referral process to connect members with all available resources, management of prior authorizations, and generation of written determination notifications.

 

The National Letter Team Letter Coordinator is responsible for drafting Notice of Action (NOA) and Notice of Extension (NOE) letters for government and commercial specific clients that adhere to the state and federal regulatory requirements. The Letter Coordinator also completes outbound calls to client-specific customers requesting the return of specific letters.

 

Primary Responsibilities:

• Drafts NOA and NOE letters for government and commercial specific clients
• Makes outbound calls to client specific customers to initiate letter retrieval
• Adherence to client, regulatory and accreditation requirements for letter documentation
• Demonstrate product knowledge by identifying the appropriate letter template based on the services and action within the case
• Consistently meet established productivity, adherence, and quality standards
• Other duties as assigned by manager and/or director

 

**ENGLISH PROFICIENCY 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 professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties OR customer service experience analyzing and solving customer problems
• Healthcare experience
• Experience working with Microsoft Outlook, Microsoft Word, and Microsoft Excel (ability to create, edit, save and send emails, documents and spreadsheets)
• Computer experience including, but not limited to, ability to learn new computer system applications
• Ability to work the hours of 08:00 am – 8:00 pm AST Monday-Friday including availability to work Saturdays from 10:00 am – 8:00 pm AST (It may be necessary, given the business need, to work Holidays, weekends and occasional overtime)
• Bilingual Proficiency (English and Spanish)

 

Preferred Qualifications:

• Experience working within a Hospital, Physician’s Office, or Medical Clinical setting, Medical Terminology, ICD – 10 and CPT codes, Medicare and / or Medicaid Services, Call Center environment
• Professional experience in a Clerical or Administrative support related role

 

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.