Referral Coordinator – Tarpon Springs, FL

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.

Positions in this function include 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.

This position is full time. Employees are required to have flexibility to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 713 S Pinellas Ave Ste A-1 Tarpon Springs FL 34689.

We offer 2 – 3 weeks of on-the-job training. The hours of the training will be aligned with your schedule. Training will be onsite.

   

Primary Responsibilities:

• 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
• Performs all other related duties as assigned

    

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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
• Must be 18 years of age OR older
• 2+ years of customer service experience
• Experience with MS Word, Excel and Outlook
• Ability to work full time. Employees are required to have flexibility to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime

    

Preferred Qualifications:

• 1+ years medical office experience with referral processing for HMO plans
• Experience working within the health care Industry and with health care insurance
• Experience working in a hospital, physician’s office or medical clinic setting
• Clerical or administrative support background
• Knowledge of ICD-10 and CPT codes

    

Soft Skills:

• Must be able to work independently, with some supervision and direction from manager
• Must possess and demonstrate excellent organizational skills, customer service skills, to include verbal and written communication
• Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all time
• Must maintain strict confidentiality at all time
• Must adhere to all department / organizational policies and procedures

    

The hourly range for this role is $16.88 to $33.22 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

  

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.

   

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